NATIONAL POSTGRADUATE COLLEGE OF NIGERIA

FACULTY OF OPHTHALMOLOGY
RESIDENCY TRAINING IN OPHTHALMOLOGY
INTRODUCTION
The ophthalmology residency training programme of the National Postgraduate Medical
College of Nigeria aims at graduating ophthalmologists competent to lead the eye care
team and for the effective eye health care delivery in Nigeria. The training is conducted
in hospitals accredited for this purpose. The programme is structured to enable graduated
acquisition of more knowledge and advanced skills as the trainee progresses in the
training.
ADMISSION REQUIREMENTS
Bachelor of Medicine, Bachelor of Surgery (MB;BS) or its equivalent from a recognized
university and full registration with the Medical & Dental Council of Nigeria; evidence
of completion of the National Youth Service Corps programme or its exemption; and a
pass in the Primary Fellowship Examinations in Ophthalmology of the National
Postgraduate Medical College of Nigeria or its equivalent.
TRAINING DURATION: The training is for a minimum of 4 years. The first 2 years of
junior residency programme leads to Part I Examination, while the last 2 years is the
senior residency programme leading to the Part II Fellowship (Final) Examination.
COMPETENCIES TO BE ACQUIRED DURING THE TRAINING
The core competencies that must be acquired during the 4-year Fellowship training
include:
Patient care with appropriate bedside manners,
Medical knowledge of the basic and clinical sciences as applied to ophthalmology
Practice-based learning
Communication skills
Professionalism
Systems-based practice and
Surgical skills

GENERAL EDUCATION OBJECTIVES

The training aims at equipping candidates to:
a. Take full history; perform full physical examinations including ocular,
neurological, neuro-ophthalmic and the uses of ophthalmic instruments
(ophthalmoscope, contact/non-contact lenses) to formulate working diagnosis.
b. Perform and interpret ophthalmic tests relevant to the patients condition
including ultrasound, visual fields, fundus photography, orthoptics, etc.
c. Request for and interpret other relevant laboratory and radiological tests findings
relevant to the patients conditions.
d. Formulate treatment and follow-up plans for the patient in a manner compatible
with evidence-based medicine.
e. Perform surgical procedures for common ophthalmic surgical disorders including
cataract, glaucoma, orbital, lid and conjunctival disorders, retinal detachment,
endophthalmitis, etc.
f.

Recognize, investigate and manage with appropriate specialties, various systemic

diseases with ocular involvement including neoplasia.

g. Communicate clearly with other members of the eye care team as well as patients
and the public. This includes ability to teach subordinates on ophthalmic
concepts and procedures.
h. Practice with bedside manners consistent with the prevalent ethical principles.
i.

Design and conduct epidemiologic and clinical ophthalmic research on prevalent

eye diseases.

j.

Design, initiative and see to fruition, blindness prevention activities within the
community in which he/she practices.

k. Effectively administer department or unit of ophthalmology within a hospital

setting.
l.

Mount advocacy for eye health services, treatment and prevention of blindness.

m. Engage in life-long professional development and education.

n. Provide effective leadership of the eye care team.

This training seeks to produce general or comprehensive ophthalmologists. Therefore, for

effective and standardized training, a structured training programme is advocated
(Appendix II) for uniformity in the country.

Primary Fellowship Examination

To enter the residency training programme the candidate must have sat for and passed the
Primary Fellowship Examination or must have earned an exemption from the
Examination by the College.
The goal of Primary Fellowship Examination is to ensure that the candidate has adequate
and broad knowledge of the basic sciences as applied to ophthalmology. It therefore tests
the candidates knowledge of anatomy, physiology, biochemistry, pharmacology,
pathology, microbiology, immunology and genetics as relevant to ophthalmology. The
Primary Fellowship Examination is an entrance examination into the residency training
programme. Details of the Primary Fellowship Examination Curriculum including the
recommended text books are presented below.
The 1st and 2nd Year Residency Training (Junior Residency)
The goals of the first 2 years of junior residency training leading to the Part I
Examination emphasize:
Recall of information and application of knowledge of the basic sciences as well
as that of the pathogenesis and patho-physiology to clinical problems;
Interpretation of clinical findings;
Formulation of diagnosis and differential diagnosis;
Development and implementation of treatment plan;
Acquisition of surgical skills as well as
Anticipation, recognition and treatment of complications.
In the first year of junior residency training the candidate is trained to be able to:
a. Describe the basic principles of optics and refraction (first 6 months to 1 year)
b. Know the indications for, as well as prescribe, common low vision aids
c. Understand the basic principles and practice of ophthalmic surgery, and
d. The trainee is required to attend the basic ophthalmic microsurgery course
within the first 6 months of the training.
e. Perform basic anterior and posterior segments ophthalmic examinations including
refraction & retinoscopy, slit lamp biomicroscopy, ophthalmoscopy, fundus
contact and non contact lens exams with 78D & 90D, Goldmann 3-mirror lens,
gonioscopy lens, IOP measurement and fluorescein staining of cornea.

f. Understand and use basic ophthalmic instruments including lensometer,

tonometer, Maddox wing, Maddox rod, Jackson cross cylinder, ophthalmoscopes,
retinoscope, phoropter, color vision test charts, etc.
g. Know how to plot and interpret visual fields.
h. Triage and treat ocular emergencies including penetrating/non-penetrating ocular
trauma, chemical burns, acute angle closure glaucoma, endophthalmitis,
panophthalmitis, corneal ulcers, EUA, etc.
i. Perform minor external and adnexal surgery including chalazion excision, corneal
foreign body removal, corneal scrapping, conjunctival biopsy, and side laboratory
tests.
j. Understand key examination techniques and management of POAG; corneal
ulcers; dry eye; lid lesions; ptosis; proptosis; maculopathy; diabetic retinopathy;
retinal detachment; optic neuropathy; pupillary abnormalities; ocular motor palsy;
etc.
k. Understand the indications, procedures and complications of cataract, and
glaucoma surgeries.
l. Describe common genetic ocular disorders including retinal and macular
dystrophies.
m. Describe and manage systemic diseases that affect the eyes.
The competencies, skills and knowledge acquired in the 1st year of training are formally
assessed, in the accredited training centre, as part of Continuous Assessment of the
candidates progress. Areas of weaknesses are identified and steps taken to rectify them.
The 2nd year of junior residency training will build confidence on the skills and
knowledge acquired during the 1st year of training.
The candidate now performs the following:
a. More difficult and more complex refraction including higher order aberrations,
refractive surgery, post-cataract (IOL) surgery refraction, refraction in children;
and putting/fitting Contact Lenses ,and use of Placcido disk.
b.

Uses more advanced low vision aids as well as understand and handle the
multiple challenges, including social and economic factors, facing the low vision
patient and his or her family.

c.

More advanced posterior segment examinations including scleral depressions;

detailed retinal examination with contact/non contact lens; description and

drawing retinal lesions; anterior segments examinations including gonioscopy;

ultrasound (A and B modes) scans.
d.

Comprehensive assessments and treatment of strabismus.

e.

Diagnose and treat ocular emergencies as well as anticipate the short and long
term complications of these emergencies.

f.

More advanced external, adnexal and orbital surgical procedures including

ectropion/entropion repairs.

g.

Examine and manage confidently secondary glaucoma, fungal and other less
common keratitis, corneal transplant, ptosis, simple retinal detachment, mild to
moderate proliferative and non-proliferative diabetic retinopathy and laser
photocoagulation, myasthenia gravis, optic neuropathy, supranuclear palsy and
complex visual field defects.

h.

The candidate should attend the neuro-ophthalmology/neurology course.

i.

Continue to update knowledge and understanding of modern cataract and

glaucoma surgical techniques.

j.

Recognize and counsel on ocular genetic disorders including retinitis

pigmentosa, neurofibromatosis, angiomatosis retina, retinoblastoma, albinism,
etc.

k.

Recognize ophthalmic
laboratory findings.

histopathologic,

hematologic

and

microbiologic

The conclusion of the 2nd year marks the end of the junior residency training. It should
be rounded off with the resident sitting for the Part I Fellowship Examinations. A
candidate becomes a senior resident (Senior Registrar) when he/she passes the Part I
Fellowship Examinations.
The Part I phase [148 CREDIT UNITS] consisting of:
Self-instructional learning for a minimum of 10 hours a week [2hours/day] for 96 weeks [24
months]
Tutorials for 1hour per week for 96 weeks
Seminars, clinical meetings, journal club, etc., for 1hour per week for 96 weeks
Clinical (including basic ophthalmic surgery) training for 30hours per week [5hours per day
for 6 days /week] for 96 weeks
Mandatory Intensive Update Courses (i.e. Clinical Ophthalmology & Optics/Refraction
Courses) 30 hours per week [6hours/day] for 2 weeks for each course

Minimum surgical experience before the Part I Exam:

Cataract: 10 assisted; 50 performed without assistance
Glaucoma: 10 assisted; 25 performed without assistance
5

(64 CREDIT UN
(6 CREDIT UN
(6 CREDIT UN

(64 CREDIT UN

(8 CREDIT UN

Penetrating globe/eye lid injuries:10 assisted; 20 performed without assistance

The supervising consultant ophthalmologist should assess and certify these surgical
procedures as at when performed. For this purpose the candidates should maintain a
Faculty-approved log book.
Compulsory Courses leading to Part I Fellowship Examination:
1.
Clinical Ophthalmology Course
2.
Optics & Refraction Course
3.
Neuro-ophthalmology Course
The 3rd and 4th Year Residency Training (Senior Residency) (72 CREDIT UNITS
including the mandatory Community Ophthalmology course & posting)
This involves more advanced training. The candidate builds on the knowledge gained
during the 1st and 2nd years of training. The candidate is expected to be involved with
decision-making in patient management; should write a proposal and commence data
gathering for the Part II (Final) Fellowship Examination dissertation and should undergo
a compulsory 3 month rural/community ophthalmology posting.
A candidate who has the opportunity can also spend extra 6-12 months in an overseas
ophthalmology training institution with a view to acquiring more competencies especially
in subspecialties of interest that are not available locally.
Towards the end of the 4th year the candidate submits a Dissertation as part requirement
for the Part II (Final) Fellowship Examination.

The specific clinical competencies to be learnt during the period include:

a. Performing competently complex refractions including higher order aberrations as
well as pre- and post- refractive surgery procedures.
b. Competently and confidently attending to low vision patients and prescribing
appropriate aids.
c. Performing and interpreting, in more details, clinical examination findings
including corneal topographic map; retinal drawing for detachment and other
lesions; A and B Scans; gonioscopy, etc.
d. Supervising and guiding competently junior residents in the management of
ocular emergencies.
e. Holding tutorials for junior residents, medical students and other paramedical
personnel in the eye care team.
f. Performing more advanced external and adnexal surgeries including lacrimal
gland surgery, repair of complex eyelid lacerations including those with
canalicular and lacrimal apparatus involvement.

g. Identifying key examination techniques and management of complex though

common medical and surgical problems in the subspecialty areas of glaucoma,
(complicated and post-operative primary and secondary open and closed angle
glaucoma); cornea (e.g. unusual or rare types of microbial keratitis, keratoplasty);
ophthalmic plastic surgery (lid lesions, recurrent ptosis); retina (e.g. complex
retinal detachment, traction retinal detachment; proliferative vitreoretinopathy);
neuro-ophthalmology (e.g. unusual optic neuropathy, neuro-imaging,
supranuclear palsy, etc); interprete plain x-rays, ultrasound, CT, MRI, OCT, etc.
of the eye and orbit.
h. Performing and treating complications of cataract and glaucoma surgeries.
i. Acquiring competencies in the efficient organization of eye care services and
leadership of the eye care team.
j.

Candidate should attend the College-organized Health Management course.

k. Acquiring competencies in biostatistics, epidemiologic and clinical ophthalmic

research and publications. Candidate should participate and publish at least 2
journal articles.
l. Candidate should attend the College-organized Research Methodology
Course.
m. Performing more advanced external and adnexal surgeries including ectropion,
entropion, eyelid lesions and ptosis, strabismus surgeries.
n. Mastering the examination techniques and management of the following:
secondary (open and closed angle) glaucoma; fungal and other microbial keratitis,
keratoplasty; ptosis surgery, Z-plasty; retinal detachment; diabetic retinopathy;
laser photocoagulation; supranuclear palsies, myasthenia gravis; nutritional and
infective/toxic optic neuropathy; headache and migraine; complex visual field
defects, neuro-ophthalmic disorders secondary to CNS defects.
o. Mastering common anterior segment surgical procedures: cataract and glaucoma
surgeries as well as management of complications.
p. Recognizing microbial, hematologic and histopathologic features of ophthalmic
disorders.
Community Ophthalmology postings:
Outreach centres and community services are ways of achieving these objectives.
Training centers should therefore embark on such community based services. The
community ophthalmology posting will endure for a total of 3 months during senior
residency. At the end of the period, the candidate should provide a formal report of the

community posting experience to the department and this will form part of the
candidates continuous assessment.
Ideally the trainee should attend the community Eye Health Course before
embarking on this posting.
Minimum surgical experience before the Part II Exam:
Cataract: Additional 50 viz: 20 ECCE/IOL, 20 SICS/IOL, and 10
phacoemulsification/IOL procedures
Glaucoma: Additional 20 trabeculectomies, including 5 releasable suture techniques
Penetrating globe/eyelid injuries: Additional 15
Laser photocoagulation of posterior segment: 10
Laser capsulotomy: 10
Laser trabeculoplasty: 10
The supervising consultant ophthalmologist should assess and certify these surgical
procedures as at when performed. For this purpose the candidate should maintain a
Faculty-approved log book and a Exercise Book with details of Surgical Notes.
Research Training
Residents are encouraged to learn the wholesome habit of systematic clinical problem
solving featuring observation, interpretation, deductive reasoning, decision-making, and
intervention followed by further observation. This habit, which resident doctors are
encouraged to acquire during training, is itself the basic requirements for competence in
research.
Besides, training institutions are obliged to institute a Research Committee and also an
Ethical Committee. These committees are expected to review research proposals from the
department for scientific content, appropriateness and compliance with international
ethical requirements. Departmental research seminars constitute the forum in which
young researchers present their projects for discussions, criticisms and the guidance of
their teachers and peers.
Teaching Skills
True to the hierarchical organization in medicine, resident doctors have the opportunity
of acquiring teaching skills during training through the practice whereby every doctor
teaches those junior to him, other members of the health team. During this period resident
doctors also learn how to as well as counsel his patients and relatives in order to achieve
effective therapeutic alliance and good clinical practice.
In addition, resident doctors have the opportunity to attend Educational Methodology
workshops; Management and Computer Courses conducted by the College. Training
institutions are encouraged to avail their residents of this opportunity.
Management Training
The secretariat of the College, conducts health management course, which senior resident
doctors should be encouraged by their training institution to attend. The second year
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senior residents should be appointed as chief residents and be given effective

opportunity to serve in management posts.
Communication Skills
It is important that ophthalmologists should be effective communicators, not only in the
ordinary running of clinical practice involving medical record documentation, case
presentation, case referral and discharge summary writing but also in the context of
scientific journal publications and indeed examination writing. Therefore the training
programme must provide opportunities for the acquisition and evaluation of various
levels of communication skills. (See Appendix III)
Continuing Education (courses, workshops, conferences, etc.)
The need for continuing medical education especially in the field of ophthalmology and
other medical specialties is just as vital as the period of residency training. Fellows of the
Faculty of Ophthalmology are encouraged to continue their ophthalmological training
throughout their active practice life. In addition to other means of achieving this, Fellows
and Associate Fellows are encouraged to take active interest in activities of the Faculty
and the College. They should also be encouraged to take advantage of modern
information technology (internet) facilities as well as attend both local and international
conferences, including association meetings, where they will have opportunity to
communicate freely with colleagues and other groups or schools of thought.
A resident doctor (Associate Fellow) should attend at least a conference (local or
international) each year. A resident should show evidence of having attended at least one
national ophthalmological conference to qualify to sit for the Part I examinations and one
additional national ophthalmological conference to qualify to sit for the Part II
examinations. Residents are encouraged to invest in their education, and not always
depend on sponsorship by the training institutions.
Compulsory Courses leading to Part II Fellowship Examination:
1. Research methodology course
2. Management course
3. Community ophthalmology course
4. Clinical Ophthalmology Course
The Part II phase [72 CREDIT UNITS] consisting of
Training in advanced clinical & surgical skills for 30hours per week [5hours per day for 6days /week]
for 48 weeks
Seminars, Tutorials, Facilitation of learning junior residents, etc., for 1hour per week for 96 weeks
Mandatory Health Management Workshops, 30 hours per week [6hours/day] for 2 weeks
Mandatory Research Methodology Workshops, 30 hours per week [6hours/day] for 2 weeks
Dissertation; proposal, literature gathering, field work, reporting.
Community ophthalmology course 30 hours per week (6 hours/day) for 4 weeks
Community Ophthalmology posting 30 hours per week (5 hours per day for 6 days /week) for 12
weeks
(8 CREDIT UNITS)

(32 CREDIT UN
(6 CREDIT UNIT
(4 CREDIT UNIT
(4 CREDIT UNIT
(10 CREDIT UN
(8 CREDIT UNIT

Training Kit:
To ensure effective training and acquisition of the necessary technical skills each resident
doctor should have a training kit containing at least the following:
Clinical & Refraction skills-

Trial lens box & frame

Direct ophthalmoscope

Indirect ophthalmoscope

Streak retinoscope

Contact & non-contact lenses: 20, 28, 78, 90D

Gonioscopy lenses

Microsurgical skills-

Corneal forceps

Suture-tying forceps

Needle holders

Spring scissors

Practice eyes e.g. phake eyes

ASSESSMENTS AND EXAMINATIONS

Continuous (In-course) Assessment
In order to effectively prepare the resident for the various parts of the FMCOph
examinations, it is advisable for the teachers to assess their residents by regular in-course
assessment exercises. Procedures which are mandatory for each clinical posting are
addressed in the resident's portfolio. Once adjudged satisfactory, such procedures are
credited to the resident. To be signed off at the end of each posting, the resident must be
judged to have satisfactorily performed all the mandatory procedures for that posting (see
Appendix III).
An end-of-posting test is highly recommended. Each year an annual report on the
progress of each resident is required to be sent to the Faculty Secretariat. The Reports
shall be: credible, documented, verifiable, & measurable (see appendix IV).
failure by the training institution to submit the candidates annual progress reports,
and correctly too, means a failure of the candidate to qualify to sit for any of the parts
i& ii fellowship examinations.
residents shall in addition keep accurate records, in separate exercise books,
throughout the duration of training for :refractions; short & long cases; wetlabs & live
10

surgical notes in full; journal club meetings, seminars/tutorials, clinical meetings;

reports of outreaches, workshops & conferences attended; records of unit posting
activities; etc, and in which they are directly involved. These shall be assessed, signed
and dated only by the supervising consultants in the accredited training centre. These
will back- up appendix IV.

CERTIFYING EXAMINATIONS OF THE COLLEGE

Application for College Certifying Examinations
The Fellowship Examinations are held twice each year in March/May and
September/November. Candidates are advised to visit the College website and comply
with the examination application requirements.
Primary Fellowship Examination
Basic sciences course in ophthalmology is organized every year by the Faculty for
candidates preparing for the Primary Fellowship Examination. For now the course takes
place in July in Benin City.
Part I Fellowship Examination
To be eligible to sit the Part I Fellowship Examination, candidates should have:
a. Passed Primary Fellowship Examinations
b. Completed the junior residency training
c. Satisfactorily performed all prescribed surgical procedures relevant to each
posting and duly signed up, as at when due in the certificate of training to that
effect.
d. Satisfactory Annual Progress Reports of training institutions Continuous
Assessments.
Candidates are eligible to write the examination at least by the 24th month of junior
residency training.

11

The Part I Fellowship Examination consists of the following sections viz:

1.
Three written papers which shall consists of:
Paper I: One 2 hour of 100 stem multiple choice questions with five branches in all
aspects of ophthalmology including medical and surgical ophthalmology, optics and
refraction, ocular pathology and public health issues in ophthalmology.
Paper 2: One written paper for 3 hours in principles of optics and refraction.
Paper 3: One written paper for 3 hours in medical and surgical ophthalmology including
ocular pathology and public health ophthalmology.
2. Clinical (Long and Short Cases and Refraction) Examinations in Ophthalmology.
Each candidate is presented with one Long Case and numerous Short Cases and one
Refraction Case. Candidates are assessed for the quality and thoroughness of:
History taking and examination techniques
Case presentation
Interpretation of clinical findings
Patient problem management
Special attention is paid to candidate's ability to foresee and prevent complications
associated with management strategy.
The objective structured clinical examination (OSCE) will eventually replace the Long &
Short Cases as well as Clinical Refraction aspects of the Part I examination.
The Faculty commenced OSCE training for examiners and candidates in May 2012 and
this training exercise will continue until May 2013 after which OSCE will replace the
traditional long & short cases and clinical refraction.
3. Practicals/Objective Structured Practical Evaluation (OSPE) shall further cover some
aspects of surgical and clinical examination skills including: interpretation of
ancillary tests results; patient problem management; surgical skills and handling of
ophthalmic diagnostic instruments.
4. Oral (Viva Voce)
The purpose of Viva Voce is to cover as wide a field as possible with the candidate.
Each candidate is subjected to 20 minutes oral examinations dealing with principles
of surgery, pre-and post-operative management, surgical pathology, diagnostic
modalities and operative surgery.
The Part I Examinations with regard to the Principles of Optics and Refraction will
emphasize tests of competencies in the following:
Instrument technology
All trainees must understand and apply knowledge of instrument technology relevant to
ophthalmic practice. They must be aware of the limitations of technologies and the risks
involved in their uses. They must be able to maintain an understanding of new
developments in relevant technologies. These include:
Direct and indirect ophthalmoscopes
Retinoscope
12

Focimeter
Simple magnifying glass (Loupe)
Lensometer
Automated refractor
Slit-lamp microscope
Applanation tonography and tonometry
Keratometer
Specular microscope
Operating microscope
Phaco machines
Zoom lens principle
Corneal pachymeter
Lenses used for fundus biomicroscopy (panfunduscope, gonioscope, Goldmann
lens, Hruby lens, 78/90D lens, etc.)
Fundus camera
Lasers
Fields machines (Goldmann, Humphrey, etc.)
Retinal and optic nerve imaging devices (OCT, SLO, GDx, etc)
The Part I Examination will specifically test competencies in the use of the following
instruments:
Visual acuity measurement charts (near and distance)
Duochrome test
Retinoscope
Focimeter / lensometer
Keratometer
Stereo tests
Jackson Cross-cylinder
Maddox Rod
Maddox Wing
Prism bar
Auto refractor
Colour vision tests
Clinical refraction shall test:
Retinoscopy
Subjective Refraction
Measurement of BVD
Muscle balance tests
Accommodative power
Measurement of IPD
Decentration of lenses and prismatic effect
Best form lens
Prescribing multifocal lenses
Prescribing for children
Cycloplegic refraction
Management of refraction results

13

Examination Results
In order to pass the Part I Examination, a candidate must obtain a pass in the combined
clinical examinations, and must pass clinical refraction, and score an aggregate 50
% pass overall.
Part II Fellowship Examination
The Part II Fellowship Examination is designed to complete the assessment of
professional competence in ophthalmology before the award of the Fellowship
qualification in Ophthalmology(FMCOph). Candidates are eligible to write the
examination at least by the 24th month of senior residency training.
Registration for Part II FMCOph Examination
Not later than 12 months before the date of the examination in which the candidate
proposes to appear and in order to be eligible to appear in the Part II examination:
1. A candidate should register the names of at least two dissertation supervisors
recognized by his/her training centre, one of whom should be a Fellow of the
College. Submit written attestations by the supervisors indicating their willingness
to supervise the project for the dissertation, i.e. collection of data, analysis of data
and general write up of the dissertation.
2. The supervisors must physically and personally monitor the work in the field and
attest to same.
3. The dissertation proposal should first be considered in a departmental seminar and
approved by the department before it can be registered for the examination.
4. The relevant institutional review board or ethical approval for the study should be
obtained before registration of the dissertation proposal with the College.
5. Submission of satisfactory Annual Progress Report by the training institution is
mandatory for the candidate to appear for the Part II examination.
The Faculty Secretary would give a feedback to the candidate on the registration of
his/her dissertation title by the Faculty Board.
The Dissertation
The objective of the dissertation is, among others, to give the candidate a chance to
demonstrate that he/she is able to clearly define a research topic and hypothesis, define
his/her research objectives, analyze and discuss his results scientifically and objectively.
The write up of the dissertation should follow the approved format, namely:
A title page featuring
The title of the work
"submitted by"
The name of the author and qualification(s)
To
"The National Postgraduate Medical College of Nigeria"
in part fulfilment of the requirements for the award of the final Fellowship of the
Medical College in Ophthalmology(FMCOph)
14

Date of Examination
The Declaration Page - In which the candidate declares that the work presented has
been done by him/her under the appropriate supervision, and that it has not been
submitted in part or full for any other Examinations or publications. Example I hereby
declare the work contained in this dissertation is original unless otherwise
acknowledged. It has not been submitted to any other college for the award of a
fellowship or degree and has not been submitted elsewhere for publication This
declaration should be signed by the candidate.
A dedication page, which is optional, may be included here.
The Attestation/Certification Page - In which the Supervisor(s) himself (themselves)
attest(s) to the fact that the work had been done, and the Dissertation written under his
(their) close supervision including a statement of his/her presence and monitoring in the
field to ensure that the study was actually carried out.
Acknowledgement Page - In which the candidate specifically acknowledges all the
assistance he/she has received in the course of the work, including copying permissions.
Specific contributions by others must be clearly stated as to leave no doubts as to what
the authors roles were.
Table of contents including appendices follows.
The Summary or Abstract - The main work begins with a structured summary of the
Dissertation featuring the key features in about 500 words with the following
subheadings: Aim(s)/objective(s); Materials & Methods; Results; and Conclusion(s).
Nothing should feature in the summary that has not been presented in greater details in
the main body if the work.
The following sections of the work should be presented in separate chapters:
The Introduction - The Introduction chapter should contain clear definition of the
problems to be studied, including what is known about the topic, gaps in knowledge,
justification for the study and a delimitation of the scope of the study. Statistical
information in this section and indeed throughout the dissertation should be stated in
actual figures and percentages for ease of understanding and for sound arguments.
Aims and objectives: should clearly and succinctly state the general aims and objectives
(or purpose) of the study as well as its specific aims and objectives targeting health and
value systems.
Review of the Literature: Should review the broad body of knowledge on the subject in
relation to the aims and objectives of the study in logical clinical sequence. Detailed
analysis, criticisms, discussions should be backed with appropriate statistics as above.

15

Materials and Methods of the study: This should be designed in relation to the aims
and objectives of the study. Depending on the study, an early consultation with a
biostatistician/epidemiologist is advised. This is the most important part of the study and
demands great details of what and how the study was actually done.
Results: When required, not more than a table or chart with its legend should be
presented on a page; the mathematical and statistical issues should be meticulosly taken
care of. It is extremely important that both the presentations and interpretations of the
data should be properly done in details.
Discussion: This section interpretes and discusses in more details the results of the study
limitations need not be presented as a separate chapter or subheading.
Conclusions and Recommendations: Clearly presents deductions and recommendations
from the study.
References: Using the system proposed by the International Committee of Medical
Journal Editors i.e. according to the Vancouver style: surname(s) of author(s),
author(s)initial(s), title of the article, abridged name of journal as per index medicus,
volume of journal, page and year e.g. Niger Postgrad Med J 2008; 15: 24 - 7.
For book references, the sequence is as follows:- Title of the book, publisher, town,
edition and year of publication. All references should be listed according to their
sequence of appearance in the text or book.
When a candidate is appearing for the oral examination on his/her Dissertation, he/she is
required to bring a copy of the Dissertation paged in the same way as the 4 unbound
copies previously submitted for the Examination.
The Part II Fellowship Examinations
The Part II Fellowship Examinations shall consist of:
a) A comprehensive oral examination on the candidate's Dissertation. The
"Dissertation orals" shall focus on candidate's accomplishment of those objectives
of the Dissertation earlier stated in this Handbook.
b) Orals on the General Principles and Practice of Ophthalmology which shall focus
respectively on:
i. Principles of ophthalmology including basic sciences
ii. Medical and surgical ophthalmology including pathology.
iii. Community/Public health ophthalmology including ophthalmology in the tropics
iv. Management skills
c) Practicals shall include Demonstration of clinical skills.
It is the responsibility of the candidate to retrieve his/her Dissertation at the end of the
Examinations. In cases of provisional pass the candidate should make all the required
corrections and submit to the College within the stipulated period of 3 months.

16

The assessors copies of all corrected dissertations must be returned, together with the
comments, through the College to the chosen assessor to whom the dissertation is
disposed to for the final assessment.
Where a candidate is to be re-examined on the same dissertation the copy of the
corrected dissertation and the copy of the previous dissertation along with the previous
assessors comments should be sent to the assessor for ease of cross-checking and to
avoid raising new issues.
Grading the Examinations performance: The overall score is 100% and distributed as
follows:
Viva Voce -33%
Practicals-33%
Dissertation- 34%
Examination Results:
In order to pass the Examinations, a candidate must:
Have his/her Dissertation accepted, and
Pass the combined Viva Voce and Practicals
Conditions for Provisional Pass, Referral in viva voce, Referral in Dissertation and
Fail:
a. A candidate who has his/her Dissertation accepted as P or P+ level but fails in
combined aggregate of Viva Voce and Practicals shall be referred in the Viva
Voce and Practicals only.
b. A candidate who scores a P- in the Dissertation and fails combined aggregate
of the Viva Voce and Practicals would be deemed to have failed the entire
Examination.
c. A candidate whose Dissertation needs some significant corrections, i.e. P- level
pass, but who had passed both Viva voce and Practicals shall have a Provisional
Pass. The corrections in the Dissertation shall be made within 3 months and must
be satisfactorily vetted by one of the Examiners before it can be accepted. Once
accepted the provisional pass is converted to a full pass by the College
d. A candidate, having passed both Viva Voce and Practicals but whose
Dissertation needs major restructuring, i.e. P-1 level, shall be referred in the
Dissertation only.
Publication of the Results
The results of the Fellowship examinations in Ophthalmology are published by th
College Registrar on approval by the Senate.
Correspondence
The National Postgraduate Medical College of Nigeria or the Faculty of Ophthalmology
does not normally enter into correspondence or discussion in respect of the details of a
candidate's performance in the Examinations.
17

DETAILS
OF
SYLLABUS
EXAMINATIONS

FOR

THE

PRIMARY

FELLOWSHIP

Anatomy
All trainees must understand and apply knowledge of the anatomy of the eye, its adnexae,
visual pathways and associated aspects of head, neck and neuro-anatomy. It extends to
applied anatomy relevant to clinical methods of assessment and investigations relevant to
ophthalmic practice. They must be able to use this knowledge when interpreting clinical
investigations and in the practice of ophthalmic surgery.
The Orbit and adnexae: Osteology, orbital foramina, eyelids, conjunctiva,
lacrimal system, extraocular muscles, intraorbital nerves, vessels, orbital fascia
Ocular anatomy: Conjunctiva, cornea, sclera, limbus and anterior chamber angle,
iris and pupils, lens and zonules, ciliary body, choroid, retina, vitreous, optic
nerve
The Cranial Cavity: Osteology of the skull, meninges, vascular supply, foramina,
cranial fossae, pituitary gland and its relations.
Central Nervous System: Cerebral hemispheres and cerebellum including
microscopic anatomy of visual cortex, cranial nerves, spinal cord, vascular
supply, visual pathways, control of eye movements, autonomic regulation of eye.
Head, neck and thorax: Nose, mouth, paranasal sinuses, face and scalp, pharynx,
soft palate, larynx, trachea, lungs, major arteries and veins, lymphatic drainage of
the head and neck.
Cardiovascular system: Gross anatomy of the thorax, heart, and major blood
vessels. Microscopic anatomy of arteries, veins and capillaries.
Physiology
All trainees must understand and apply knowledge of the physiology of the eye, adnexae
and nervous system, including related general physiology. This includes the applied
physiology relevant to clinical methods of assessment in ophthalmic practice. They must
be able to use this knowledge when interpreting clinical symptoms, signs and
investigations and in the practice of ophthalmic medicine and surgery.
General principles including:
Maintenance of homeostasis: Characteristics of control systems - nervous and
hormonal.
Body fluids - volume, osmolarity, osmotic and oncotic pressure, and electrolyte
(including H+) concentrations.
Excitable tissues nerve and muscle: Structure and function of nerve cell,

18

membrane potential, action potential, nerve conduction, synapse, the motor unit,
muscles.
Blood: Plasma composition and functions, cell types, immune mechanisms, blood
groups, haemoglobin and red and white cell formation and destruction, anaemias,
clotting and fibrinolysis.
Cardiovascular system: Pressure resistance and flow in blood vessels, blood
pressure.
And blood flow, the activity of the heart and its control, cardiac output, control
Mechanisms within the CVS, transcapillary exchange, tissue fluid formation.
Respiratory system: Structure, lung volumes, composition of respiratory gases,
lung.
mechanics, gas exchange in the lung, carriage of O2 and CO2 in blood, ventilation
perfusion relationships, chemical and neural control of ventilation.
Nervous system and special senses: Receptors, synapses, afferent pathways,
efferent pathways, cerebral cortex, control of movement, hearing, pain and its
control, autonomic nervous system, cholinergic transmission, adrenergic
transmission.
Endocrinology: Hormonal control, hypothalamus, pituitary, thyroid / parathyroid,
adrenals, pancreas.
Nutrition: Dietary requirements, absorption, vitamins.
Kidney and adrenal cortex: Glomerular and tubular functions, osmolality and pH
of body fluids.
Ocular physiology including:
Physiology of tear production and control, and the lacrimal drainage system.
Physiology of aqueous production and drainage including principles of intraocular
pressure measurement.
Physiology and biochemistry of the cornea.
Lens metabolism.
Physiology of the vitreous.
Retinal physiology including phototransduction.
Retinal pigment epithelium.
Choroid.
Blood ocular barriers.
Physiology of vision including:
Visual acuity,
Accommodation,
Pupillary reflexes,

19

Light detection,
Dark adaptation,
Colour vision,
Electrophysiology of the visual system,
Visual fields,
Contrast sensitivity,
Eye movements,
Stereopsis,
Motion detection,
Visual perception,
Magnocellular and parvocellular pathways.

Biochemistry and cell biology:

All trainees must understand and apply knowledge of the basic biochemistry and cell
biology. This includes in particular those aspects relevant to common eye diseases. They
must be able to use this knowledge when interpreting clinical symptoms, signs and
laboratory investigations and in the practice of ophthalmic medicine and surgery.
Biochemistry of the cell: Organelles, plasma membranes, cytoskeleton,
nucleus (DNA, RNA), transport mechanisms, cell-cell communications,
cell-matrix interactions.
Signaling: Growth factors, cytokines, hormones, eicosanoids, receptors, signal
transduction, intracellular signaling pathways (e.g. second messengers).
Cellular processes: Cell cycle, protein synthesis (transcription, translation, posttranslational modification), nucleic acid synthesis, proliferation, migration,
apoptosis, metabolic processes.
Connective tissue and extracellular matrix: Extracellular matrix molecules,
composition of ocular extracellular matrices, synthesis/degradation, cell-matrix
interactions.
Biochemical and molecular biological techniques: Examples include: gene
cloning, polymerase chain reaction, in-situ hybridization, immuno-localization,
ELISA assays, Western, Northern and Southern blotting.
Biochemistry and cell biology of ocular tissues: Cornea, sclera, ciliary body, lens,
vitreous, retina, choroid.
Active oxygen species: Free radicals and H2O, scavengers, lipid peroxidation,
phospholipase A.
Pathology:

20

All trainees must understand and apply knowledge of pathology, especially the specialist
pathology of the eye, adnexae and visual system. This includes histopathology,
microbiology and immunology and other branches of pathology. They must be able to
use this knowledge when interpreting clinical symptoms, signs and investigations and in
the practice of ophthalmic medicine and surgery.
Acute inflammation: Chemical mediators, cellular mechanisms.
Wound healing.
Chronic inflammation: Types, granulomata, immune mechanisms, ulcerations,
specific examples of.
Immunological mechanisms: Types of hypersensitivity reactions.
Graft rejection.
Degenerations: Examples: amyloidosis, calcification.
Ageing and atrophy.
Hypertrophy, hyperplasia and metaplasia.
Vascular disorders: Atheroma, thrombosis (and homeostatic clotting mechanisms
embolism (including pulmonary embolism), ischaemia and infarction, congestion
and oedema, angiogenesis, hypertension, aneurysms, diabetic microangiopathy,
Shock.
Neoplasia: Definition, terminology, concepts; benign and malignant tumours;
carcinogenesis; gene control including regulation of apoptosis; oncogenes;
geographical and environmental factors; pre-neoplastic conditions; effects of
irradiation and cytotoxic drugs.

BASIC OCULAR PATHOLOGY

With an emphasis on:
Cornea endothelial dysfunction and corneal dystrophies,
Glaucomas,
Cataract,
Diabetes,
Age -Related Macular Degeneration,
Retinal vascular occlusion,
Ocular neoplasia,
Retinal detachment and Proliferative Vitreo-retinopathy.
MICROBIOLOGY:
The biological and clinical behaviour of the micro-organisms responsible for
infections.
Elementary principles of microbial pathogenesis: Concepts of colonisation,
invasion, endotoxins, exotoxins, virulence and pathogenicity etc.
Gram staining and classification.
Commensal eye flora.
Viruses: Classification, structure and replication, antiviral agents, laboratory
methods of viral detection; viral infections of the eye.
Prions.

21

HIV and AIDS.

Fungi: Classification, factors which predispose to fungal infection, antifungal
agents.
Toxoplasmosis, Chlamydia, Acanthamoeba, Helminthic infections.
Principles of sterilization: Disinfection and asepsis and the application of these to
current practices and practical procedures.
Antimicrobials: Spectrum of activity, mode of action, pharmacokinetics and
resistance.
IMMUNOLOGY :
Principles of immunology e.g. non-specific resistance, genetic basis of immunity,
cellular and humoral mechanisms.
Host defence mechanisms with particular reference to the eye.
Mechanisms of immunologically-induced tissue damage with special reference to
the eye.
Role of soluble mediators (cytokines and chemokines) in regulation of
inflammatory responses .
MHC antigens, antigen presenting cells and antigen processing.
Transplantation immunology (with particular reference to the cornea).
Immunodeficiency and immunosuppression.
Tissue regulation (with particular reference to the eye) of inflammatory responses.

Growth and senescence:

All trainees must understand and apply knowledge of growth, development and
senescence, and the anatomical, physiological and developmental changes which occur
during embryogenesis, childhood, and ageing, relevant to ophthalmic practice. They must
be able to use this knowledge when interpreting clinical symptoms, signs and
investigations and in the practice of ophthalmic medicine and surgery.
Embryology: General embryology especially at early stages; embryology of the
eye, orbit, adnexae, and visual pathways; the embryological origins of congenital
malformations of the eye.
Child development: Key milestones in childhood development especially
regarding the visual and central nervous systems.
Senescence: the process of ageing and degeneration.
Therapeutics:
All trainees must understand and apply knowledge of clinical therapeutics relevant to
ophthalmic practice. They must be able to use this knowledge when prescribing for
patient. They must understand the therapeutics used in general medicine and surgery to

22

basic standard. They must be aware of the possible ocular effects of systemic medications
and systemic effects of ocular medications.

PHARMACOLOGY:
Pharmacokinetics and pharmacodynamics: General and specific to ocular tissues.
Drug-receptor interactions.
Mechanisms of drug actions (including receptor pharmacology and biochemical
pharmacology).
Mechanisms of drug toxicity.
Specific classes of pharmacological agents: Examples include catecholaminergics,
cholinergics, serotonergics and histaminergics, eicosanoids.
Pharmacology of drugs used in inflammation and immunosppression.
Pharmacology of drugs used in glaucoma.
Local (General) anaesthetics.
Analgesics.

Clinical Genetics:
All trainees must understand and apply knowledge of clinical genetics relevant to
ophthalmic practice. They must be able to use this knowledge when advising patients
about patterns of inheritance. They must recognise when it is appropriate to refer a
patient for genetic counseling. They must recognise when it is important to offer a
consultation with family members.
Organisation of the genome: Genes, chromosomes, regulation of transcription.
Mendelian genetics: General principles.
Population genetics: General principles.
Cytogenetics: Aneuploidy, deletions, translocations, mosaicism, chimerism.
Genetic basis of eye conditions: Genes involved in ocular disorders or systemic
disorders with an ocular phenotype.

23

Investigative and research techniques: Linkage analysis, candidate genes, twin

studies, association studies.
Gene therapy: General principles.
Suggested reading list for Primary Fellowship Examinations:
This list is not exhaustive but definitely useful for preparing for the Primary Fellowship
Examination.
The Eye: Basic Sciences and Practice. Forrester JV, Dick AD, McMenamin P, Lee WR.
WB Saunders 2003. ISBN: 0-7020-2541-0
MCQ companion to the Eye. Basic Sciences in Practice. Galloway PH, Forrester JV,
Dick AD, Lee WR. WB Saunders 2001. ISBN: 0702025666
American Academy of Opthalmology. Basic and Clinical Science Course. ISBN: 156055-570-X
Volume 1. Update on general medicine.
Volume 2. Fundamentals and principles of ophthalmology
Volume 4. Ophthalmic pathology and intraocular tumours.
Adlers Physiology of the Eye. Ed. Hart WM. Mosby 2003. ISBN: 0-323-01136-5
Clinical Anatomy of the Eye. Snell RS, Lemp MA. Blackwell Scientific Publications
1998. ISBN: 063204344X
Clinically orientated anatomy. Moore KL, Dalley AF. Lippincott Williams and Wilkins
2005. ISBN: 0781736390.
Pathology for Surgeons in Training: An A-Z revision text. Gardner DL and Tweedle
DEF. Arnold 2002. ISBN: 0340759046
Ocular Pathology, 5th ed. Yanoff M and Fine BS. Mosby 2002. ISBN: 0323014038
Medical Microbiology. Greenwood D, Slack R, Peutherer J. Churchill Livingstone 2002.
ISBN 0443070776
Medical pharmacology at a glance. Neal MJ. Blackwell Publishing 2002. ISBN:
0632052449
Clinical Ocular Pharmacology. Jaanus SD, Barlett JD. Butterworth-Heinemann 2001.
ISBN: 0750670398

24

Genetics for Ophthalmologists: The molecular genetic basis of ophthalmic disorders.

Black GCM. Remedica Publishing 2002. ISBN: 190134620X
Biochemistry of the eye. Whikehart R. Butterworth-Heinemann 2003. ISBN:
0750671521

DETAILS OF THE SYLLABUS FOR JUNIOR & SENIOR RESIDENCY

PROGRAMMES
OPTICS
JUNIOR RESIDENCY
A. Cognitive skills
1. To describe the basic optics of the human eye (e.g. ametropia, astigmatism,
hypermetropia, myopia, presbyopia, aniseikonia, anisometropia, aphakia)
2. To describe the importance of pupil size and its effect on optical resolution.
3. To list the various refractive surfaces.
4. To describe the optical parameters affecting retinal image size
5. To describe a schematic eye and reduced eye.
6. To describe the following terms related to magnification
a. Linear
b. Angular
c. Relative size
d. Electrons
7. To describe the following terms relative to visual acuity testing
a. Distance and near acuity measurement
b. Minimal - LogMAR
1) Visible
2) Perceptible
3) Separable

25

4) Legible
c. Vernier acuity
8. To describe the indications for, interpret basic tests of contrast sensitivity and
color vision (e.g. Ishihara color plates, Hardy-Rand-Rittler plates, FarnsworthMunsell testing).
9. To describe the following terms and the clinical applications for each
a. Physical optics
1. Properties of light
Wave theory of light
2) Images
3) Objects as light sources
4) Laws of refraction
a) Passage of light from one medium to another
b) Absolute index of refraction
c) Total reflection
d) Vergence of light
i)
Diopter
ii)
Convergence
iii)
Divergence
iv)
Vergence formula
e) Real/virtual objects and images
f) Interference and coherence
g) Polarization
h) Diffraction/diffusion
i) Scattering
j) Transmission and absorption
k) Illumination
l) Pinhole imaging
m) Image quality
n) Brightness radiance
o) Light propagation-optical media and refractive index
p) Ray tracings
10. To describe the following optical concepts in clinical context
a. Geometrical optics
i)
Optical interfaces
ii)
Objects and images at infinity
iii)
Refractive index
iv)
Snells Law
v)
Multiple lens systems
b. Mirrors
i)
Laws of reflection
ii)
Critical angle

26

iii)
iv)
v)
vi)

Regular and diffuse reflection

Image and field of a plane mirror
Focal point and focal length of spherical mirror
Critical angles

c. Prisms
i)
Types
ii)
Refraction of light through a prism
iii)
Total internal reflection
iv)
Ophthalmic prisms
v)
Thin prisms
vi)
Prism diopters
vii)
Minimum deviation
viii) Prismatic effect of lenses
ix)
Prentice rule
x)
Fresnels prisms
d. Lenses
i)
Diopter
i)
Concave and convex
ii)
Vertex power/lens effectivity
iii)
Sphero-cylinder lenses
iv)
Cross cylinders
v)
Conoid of Sturm
vi)
Transposition: plus cylinder versus minus cylinder
vii)
Focal points and focal planes
viii) Principal planes and principal points: Thin versus Thick lens
ix)
Focal length
x)
Reflection and refraction at curved surfaces
xi)
Simple lens formula
e. Lens aberrations
i)
Spherical aberration
ii)
Coma
iii)
Astigmatism
iv)
Distortion
v)
Aberration
vi)
Pantoscopic tilt
f. Lens Materials
i)
Lens styles/materials
ii)
Slab off prism
iii)
Aphakic spectacles
g. Instruments
i)
Lensometer

27

ii)
iii)
iv)
v)

Slit lamp biomicroscope

Retinoscope
Direct ophthalmoscope
Indirect ophthalmoscope

h. Telescope
i)
Galilean
ii)
Keplerian
- Aniseikonia
- Knapps Rule
B. Technical skills
1. To perform basic refraction of simple refractive errors.
2. To perform basic assessment of corneal topography (e.g., Placcido disc,
keratometry, automated corneal topography).
3. To perform the following basic refractometric techniques.
a. Retinoscopy
b. Objective and subjective refraction (manifest and cycloplegic
refraction and post-cycloplegic refractions)
c. Use of cylinders
d. Application of cross cylinder technique
e. Refining sphere and cylinder
f. Duochrome technique
g. Binocular balancing
h. Presbyopia, measuring for near adds
i. Refracting the basic low vision patient
4. To describe and apply in clinical settings the following basic concepts.
a. Snells Law
b. Refraction and axial myopia
c. Refraction and axial hypermetropia
d. Cylinder lenses and pinhole
5. To describe and to apply in clinical settings the following concepts on
accommodation and convergence.
a. Amplitude of accommodation
b. Near point of accommodation
c. Effects of spectacles and contact lenses
d. Far point
e. Near point

SENIOR RESIDENCY:
Trainee should acquire improved proficiency in basic level skills in optics and refraction.

28

In addition to the standard and basic level goals the trainee should apply the relevant
optics information above in the following situations:
1. Refraction and prescribing of spectacles and contact lenses
2. Intraocular lens calculation
3. Cataract surgery
4. Use of prisms for diplopia
5. Low vision aid prescribing
RETINOSCOPY AND REFRACTION
Overall goals:
i. To identify the principles and indications for retinoscopy;
j. To perform the techniques of retinoscopy;
k. To identify media opacities and other ocular co-morbidities with
retinoscopy, and
l. To perform an integrated refraction based upon retinoscopic results.
Basic Level Goals (Junior Residency)
1. To describe the major types of refractive errors;
2. To perform elementary refraction techniques (eg., for myopia,
hyperopia, accommodative add);
3. To perform subjective refraction techniques for simple refractive
error.;
4. To describe basic ophthalmic optics and optical principles of
refraction and retinoscopy;
5. To perform retinoscopy for detecting simple refractive errors;
6. To describe the indications for and to use trial lenses or a phoropter
for simple refractive error, and
7. To describe the basic principles of keratometer.
Standard Level Goals: (Junior residency)
In addition to Basic Level Goals, the trainee should be able:
1. To describe more complex types of refractive errors,
including post-operative refractive errors;
2. To perform more advanced refractive techniques (eg.,
astigmatism,
complex
refractions,
asymmetric
accommodative add);
3. To perform objective and subjective refraction techniques
in more complex refractive errors, including astigmatism
and post-operative refractive error;
4. To describe the more advanced ophthalmic optics
principles of refraction and retinoscopy (eg., postkeratoplasty, post-cataract extraction);

29

5. To perform more advanced techniques of retinoscopy for

detecting simple and complex refractive error;
6. To describe and use more advanced techniques using trial
lenses or the phoropter for more complex refractive errors,
including modification and refinement of subjective
manifest refractive error and more complex refractive
errors (eg., advanced and irregular astigmatism , vertex
distance), and
7. To use the keratometer for detection of more advanced
refractive error.
Advanced Level Goals (Senior Residency)
In addition to Standard Level Goals the trainee should be able:
1. To describe the most complex types of refractive
errors, including post-operative refractive errors,
post-keratoplasty, and refractive surgery;
2. To perform the most advanced refraction techniques
(eg., irregular astigmatism, pre-and post-refractive
surgery);
3. To perform objective and subjective refraction
techniques in the most complex refractive error,
including astigmatism and post-operative refractive
errors;
4. To describe the most advanced ophthalmic optics
and optical principles of refraction and retinoscopy,
including higher order aberrations;
5. To utilize the most advanced ophthalmic optics and
optical principles of refraction and retinoscopy,
including higher order aberrations;
6. To perform the most advanced techniques using
trial lenses or the phoropter for more complex
refractive errors, including modification and
refinement of subjective manifest refraction, and
post-cycloplegic refraction, irregular astigmatism,
post-keratoplasty, and refractive surgery cases;
7. To use the keratometer for detection of subtle or
complex advanced refractive error, and

30

8. To use more advanced refraction instruments and

techniques (e.g. distometer, automated refractor,
corneal topography).

CATARACT AND LENS

General Goals:
A. To describe the indications, evaluation and management, and intra and postoperative complications of cataract surgery and other anterior segment
procedures;
B. To perform the complete pre-operative ophthalmologic examination of cataract
patients;
C. To formulate the differential diagnoses of cataract and evaluate the normal and
abnormal lens;
D. To perform optimum refraction of the post-cataract surgery patient;
E. To develop and exercise clinical and ethical decision-making in cataract patients;
F. To develop good patient communication techniques regarding cataract surgery;
G. To perform routine and advanced cataract surgery and intraocular lens (IOL)
placement;
H. To manage basic and advanced clinical and surgical cataract problems;
I. To effectively diagnose and manage intra-operative and post-operative
complications of cataract surgery;
J. To work effectively as a member of the medical care team, and
K. To develop teaching skills about cataracts for training junior trainees and students.

JUNIOR RESIDENCY YEAR 1

A. Cognitive Skills:

31

a. To identify the most common causes and types of cataract (e.g. anterior polar,
cortical nuclear sclerotic, posterior sub-capsular);
b. To list the basic history and examination steps for cataract evaluation preoperatively;
c. To describe the steps in cataract surgical procedures;
d. To define the elementary refraction or contact lens fitting techniques prior to
considering cataract extraction to obtain best corrected vision;
e. To describe the major etiologies of dislocated or subluxated lens (e.g. trauma,
Marfan's syndrome, homocystinuria, Weill-Marchesani syndrome, syphilis);
f. To be familiar with the techniques of intracapsular cataract extraction,
extracapsular cataract extraction, and phacoemulsification;
g. To describe the following:
a. Basic ophthalmic optics as related to cataracts
b. Types of IOLs
c. Types of refractive error in cataract
d. Retinoscopy techniques for cataracts
e. Subjective refraction techniques for cataract patients.
h. To identify and describe the mechanisms of the following instruments in the
evaluation of cataracts, including:
a. Lensometer
b Autorefractor
c. Retinoscope
d. Phoropter
e. Keratometer
f. Slit lamp biomicroscope
g. Glare and contrast testing devices
h. Potential acuity metre.

B. Technical/surgical skills:
a. To perform basic slit lamp biomicroscopy, retinoscopy, and ophthalmoscopy.
b. To evaluate and classify common types of lens opacities.
c. To perform subjective refraction techniques and retinoscopy in patients with
cataracts.
d. To perform direct and indirect ophthalmoscopy pre- and post-cataract surgery.
e. To perform basic steps of cataract surgery (e.g. incision, wound closure) in the
practice lab.
f. To assist at cataract surgery and perform patient preparation, sterile draping,
anesthesia.

32

g. To perform the following steps of cataract surgery in the practice lab or under
direct supervision, including any or all of the following:
a. Wound construction
b. Anterior capsulotomy/capsulorrhexis
c. Instillation and removal of viscoelastics
d. Extracapsular, manual small incision sutureless cataract surgery (SICS)
and or phacoemulsification techniques
e. Irrigation and aspiration
f. Intraocular (IOL) implantation techniques
JUNIOR RESIDENCY YEAR 2
A. Cognitive Skills:
1. To describe the less common causes of lens abnormalities (e.g. spherophakia,
lenticonus, ectopia lentis).
2. To describe the pre-operative evaluation of the cataract patient, including:
a. The systemic diseases of interest or relevance to cataract surgery.
b. The relationship of external and corneal diseases of relevance to cataracts and
cataract surgery (e.g., lid abnormalities, dry eye).
c. The relationships of glaucoma and capsular opacities related to cataract surgery
3. To describe glare analysis testing for cataract surgery.
4. To describe the use of A and B scan ultrasonography in cataract surgery.
5. To describe the instruments and techniques of cataract extraction, including
extracapsular surgery and phacoemulsification (e.g. trouble-shooting the
phacoemulsification machine, altering the machine parameters).
6. To describe the types, indications and techniques for anesthesia for cataract surgery
(e.g. topical, local, general).
7. To describe indications, techniques, and complications of surgical procedures,
including:
a. Extracapsular surgery
b. Manual small incision sutureless cataract surgery (SICS)
c. Phacoemulsification
d. Paracentesis
8.

To describe the indications for, principles of, and techniques of YAG laser
capsulotomy.

9.

To describe history and techniques of basic IOL implantation.

10.

To correlate the level of visual acuity with the lens opacities.

11.

To describe the common complications of cataract and anterior segment

surgery (eg., intraocular pressure elevation, hyphema, endophthalmitis,

33

cystoid macular edema, retinal detachment, intra-ocular lens dislocation,

lens-induced glaucoma and uveitis).
B. Technical/surgical Skills:
1. To perform local injections of corticosteroids, antibiotics, and anesthesia.
2. To implement the basic preparatory procedures for cataract surgery (e.g. obtaining
informed consent, identification of instruments, sterile technique, gloving and
gowning, prep and drape, other preoperative preparation).
3. To perform graduated extracapsular surgery in a practice setting (e.g. animal or
practice lab) and then in the operating room under supervision, including mastery of
the following skills:
a. Wound construction
b. Anterior capsulotomy/capsulorrhexis
c. Instillation and removal of viscoelastics
d. Extracapsular technique
e. Beginning phacoemulsification techniques
f. Irrigation and aspiration
g. IOL implantation techniques
4.

To perform paracentesis of the anterior chamber.

5. To use the operating microscope for basic cataract surgery.

6. In addition to performing the appropriate steps in cataract surgery, to assist in cataract
surgery and perform more advanced steps in patient preparation and anesthesia.
7. To describe the more advanced applications of visco-elastics in surgery (e.g. control
of iris prolapse, elevation of dropped nucleus, visco-dissection).
8. To recognize and refer or treat common post-operative complications of cataract
surgery (e.g. endophthalmitis, elevated intraocular pressure, cystoid macular edema,
wound leak, uveitis).
9. To perform basic post-operative evaluation of the cataract patient.
SENIOR RESIDENCY
A. Cognitive Skills:
1. To define the more complex indications for cataract surgery (e.g. better view of
posterior segment), describe the performance of and describe the complications of
more advanced anterior segment surgery (e.g. pseudoexfoliation, small pupils,
mature cataract, hard nucleus, black cataract, post-traumatic, zonular dehiscence),
including more advanced procedures (e.g. secondary IOLs and indications for
specialized IOLs, capsular tension rings, iris hooks, use of methyl blue or
indocyanine green staining).
2. To describe the indications for, techniques of, and complications of cataract
extraction in the context of the subspecialty disciplines of glaucoma (eg.,
34

combined cataract and glaucoma procedures, glaucoma in cataractous eyes,

cataract surgery in patients with prior glaucoma surgery), retina (e.g. cataract
surgery in patients with scleral buckles or prior vitrectomy), cornea (e.g. cataract
extraction in patients with corneal opacities), ophthalmic plastic surgery (e.g.
ptosis following cataract. surgery), and refractive surgery (e.g. cataract surgery in
eyes that have undergone refractive surgery).
3. To independently evaluate complications of cataract and IOL implant surgery (e.g.
posterior capsular tears, choroidal effusions).
4. To describe the instruments and techniques of cataract extraction including
extracapsular surgery and phacoemulsification (e.g. trouble-shooting the
phacoemulsification machine, altering the machine parameters)
5. To understand indications for and technique of intracapsular surgery (e.g. rare
cases may require this procedure or patients may have had the procedure
performed previously).
6. To describe indications for and instrumentation and techniques used to implant
foldable and non-foldable IOLs.
7. To describe the evaluation and management of common and uncommon causes of
post-operative endophthalmitis.
8. To perform repositioning, removal or exchange of IOLs.
9. To assist in the teaching and supervision of basic and standard level learners (i.e.
first and second year residents).
10. To describe the government and hospital regulations which apply to cataract
surgery.
B. Technical/surgical Skills:
1. To describe the indications for, mechanics of, and performance of A-scan
ultrasonography and calculation of IOL power.
2. To perform phacoemulsification in a practice setting (e.g. animal or practice lab)
and then in the operating room, including mastery of the following skills:
a. Wound construction
b. Anterior capsulotomy/capsulorrhexis
c. Viscoelastics
d. Extracapsular and phacoemulsification-techniques (eg., sculpting, divide and
conquer, phaco-chop, stop and chop)
e. Instrumentation and techniques of irrigation and aspiration
f. IOL implantation (eg., anterior and posterior, special IOLs)
g. IOL repositioning, removal or exchange
35

3. To perform implantation of foldable and non-foldable IOLS.

4. To perform intraoperative and postoperative management of any event that may
occur during or as a result of cataract surgery, including:
a. Vitreous loss
b. Capsular rupture
c. Anterior or posterior segment bleeding
d. Positive posterior pressure
e. Choroidal detachments
f. Expulsive hemorrhage
g. Elevated intraocular pressure
h. Use of topical and systemic medications
i.
Astigmatism
j.
Post operative refraction (simple and complex)
k. Corneal edema
l.
Wound dehiscence
m. Hyphema
n. Residual cortex
o. Dropped nucleus
p. Uveitis and cystoid macular edema (CME)
q. Elevated intraocular pressure and glaucoma

Contact Lens
JUNIOR RESIDENCY YEAR 1
A. Objectives:
1. To perform a basic contact lens (CL) history and examination, and to be aware of
additional basic tests and questions that are required for CL patients with more
complex needs.
2. To perform the techniques of retinoscopy, refraction, and over-refraction in the
routine CL patient.
3. To describe the optics of the soft contact lens and hard contact lens (e.g. rigid
gas permeable CL); base curve changes, the lacrimal lens, and the optic zone.
4. To describe conversion of a spectacle prescription (Rx) to a CL Rx, including
method of converting from plus to minus cylinder.
5. To describe basic CL design, using appropriate terminology.
6. To describe techniques for and perform basic CL fitting.
7. To describe selection of CL candidates with non-complex needs.
8. To use auxiliary CL instruments and tests (e.g. trial set, fluorescein testing).
9. To perform CL verification for vision correction, fit, and comfort.
10. To describe contraindications for contact lens use.

36

B. Cognitive Skills:
1. To describe fundamentals of ophthalmic optics in CL management (e.g. CL
choices,
techniques for fitting individuals).
2. To list indications for contact lenses in non-complex cases.
3. To describe CL choices and techniques for fitting individuals with non-complex
CL needs.
C. Technical Skills:
1. To perform advanced retinoscopy techniques in a CL patient.
2. To perform advanced refraction techniques in a CL patient, including diagnostic
fitting.
3. To perform techniques to verify and inspect contact lenses.
4. To utilize appropriate teaching skills to instruct patients in the safe insertion,
removal, and care of contact lenses.
SENIOR RESIDENCY I
A. Objectives:
1. To perform a more advanced CL history and examination, employing additional
tests and questions appropriate for patients with more complex CL needs (e.g.
keratoconus, difficult CL fittings).
2. To perfom retinoscopy and refraction in the CL patient with more complex needs
(e.g. keratoconus, post-keratoplasty).
3. To describe the more advanced optics of the soft contact lens (SCL) and hard
contact lens (e.g. rigid gas permeable CL); base curve changes, the lacrimal lens,
and the optic zone.
4. To describe more advanced CL design (e.g. special lenses and special CL shapes or
materials).
5. To describe and perform more advanced CL fitting (e.g. post-keratoplasty).
6. To describe selection of CL candidates with more complex needs (e.g. postsurgical).
7. To use auxiliary CL instruments in patients with more complex needs (e.g. postsurgical topography).
8. To perform CL verification for vision, fit, and comfort in therapeutic CL care.
B. Cognitive Skills:
1. To describe more advanced concepts of ophthalmic optics in CL.

37

2. To describe indications for more advanced CL (eg., therapeutic lenses).

C. Technical Skills:
1. To perform more advanced retinoscopy techniques in a CL patient.
2. To perform more advanced refraction techniques in CL patient, including
diagnostic fitting.
3. To perform advanced techniques to verify and inspect contact lenses in patients
with complex CL needs.
4. To perform more advanced CL fitting in patients with complex needs (e.g.
keratoconus, CL in children, active corneal disease).
5. To describe and use the CL instruments in more complex cases.
6. To describe the more advanced CL complications (e.g. microbial keratitis, sterile
corneal infiltrates, preservative toxicity)
7. To perform appropriate CL selection (e.g. material selection, CL modification).
8. To perform corneal topography to fit contact lenses.
SENIOR RESIDENCY II
A. Objectives:
1. To perform the most advanced techniques in CL history and examination, and to
understand what additional tests and questions are needed during the most complex
CL examination (e.g. post-keratoplasty, multiple surgery, post-refractive, complex
keratoconus fitting, active corneal disease).
2. To perfom retinoscopy and refraction in the CL patient with the most complex
needs (e.g. keratoglobus, keratoconus, following open globe repair (e.g. corneal
laceration] or multiple keratoplasty).
3. To describe the most advanced optics and applications of soft contact lenses and
hard contact lenses (e.g. piggyback CL).
4. To describe the most advanced CL design, using appropriate terminology (e.g.
special fittings, special lenses for difficult-to-fit patients).
5. To describe indications for and to perform the most advanced CL fitting (e.g. postmultiple keratoplasty or traumatic corneal repair).
6. To describe indications for and apply the most complex CL in special
circumstances or for candidates presenting increased level of difficulty (eg., post
surgical patients, children)
38

7. To use the auxiliary CL instruments in patients with the most complex needs (e.g.
topography, fluorescein testing, diagnostic lenses).
A. Cognitive Skills:
1. To describe the differences between CL material choices.
2.

To describe methods of modifying a contact lens to improve comfort, vision, or

physiological response.

3. To evaluate and to manage CL-induced complications.

4. To perform and interpret corneal topography in CL fitting.
c. Technical Skills:
1. To perform CL modification in complex cases.
2. To select the appropriate CL in more complex cases.

CORNEA, EXTERNAL DISEASE AND REFRACTIVE SURGERY

JUNIOR RESIDENCY YEAR I
A. Cognitive skills:
1. To describe the basic anatomy, embryology, physiology, pathology, microbiology,
immunology, genetics, epidemiology, and pharmacology of the cornea,
conjunctiva, sclera, eyelids, lacrimal apparatus, and ocular adnexa.
2. To describe congenital abnormalities of the cornea, sclera, and globe (e.g. Peters'
anomaly, microphthalmos, birth trauma, buphthalmos).
3. To describe characteristic corneal and conjunctival degenerations (e.g. pterygium,
pinguecula, Salzmann, senile plaques of the sclera, keratoconus ).
4. To recognize the common corneal dystrophies and degenerations (e.g. map-dotfingerprint dystrophy, Meesman's dystrophy, Reiss Buckler dystrophy, Francois
dystrophy, Schnyder dystrophy, congenital hereditary stromal dystrophy, lattice
dystrophy, granular dystrophy, macular dystrophy, congenital hereditary
endothelial dystrophy, Fuchs' dystrophy, posterior polymorphous dystrophy,
Salzmann's degeneration).
5. To recognize the common corneal inflammations and infections (e.g. herpes
simplex, syphilis, interstitial keratitis).
6. To understand the fundamentals of corneal optics and refraction (e.g. keratoconus).
7. To describe the fundamentals of ocular microbiology and recognize corneal and
conjunctival inflammations and infections (e.g. staphylococcal hypersensitivity,
39

simple microbial keratitis, simple conjunctivitis, trachoma, ophthalmia

neonatorum, herpes zoster ophthalmicus, herpes simplex keratitis and
conjunctivitis).
8. To recognize the basic presentations of ocular allergy (e.g. phlyctenules, seasonal
hay fever, vernal conjunctivitis, allergic and atopic conjunctivitis, giant papillary
conjunctivitis).
9. To recognize and treat lid margin disease (e.g. staphylococcal blepharitis,
meibomian gland dysfunction).
10. To describe the features of, diagnose, and treat (or refer) Vitamin A deficiency
(e.g. Bitot spots, dry eye, slowed dark adaptation) and neurotrophic corneal
disease.
11. To describe the basic differential diagnosis of the acute and chronic conjunctivitis
or "red eye" (e.g. scleritis, episcleritis, conjunctivitis, orbital cellulitis, gonococcal
and chlamydial conjunctivitis).
12. To describe the basic mechanisms of traumatic and toxic injury to the anterior
segment (e.g. alkali burn, lid laceration, orbital fracture, etc.).
13. To understand the mechanisms of ocular immunology and recognize the external
manifestations of anterior segment inflammation (e.g. red eye associated with
acute and chronic iritis).
14. To describe the basic principles of ocular pharmacology of anti-infective, antiinflammatory and immune modulating agents (e.g. indications and
contraindications for topical corticosteroids and antibiotics).
15. To recognize corneal lacerations (perforating and non-perforating), pterygia that
may require surgery, corneal and conjunctival foreign bodies.
16. To diagnose and treat corneal exposure (e.g. lubrication, temporary tarsorrhaphy).
17. To describe the epidemiology, differential diagnosis, evaluation and management
of common benign and malignant lid lesions, including pigmented lesions of the
conjunctiva and lid (e.g. nevi, melanoma, primary acquired melanosis)
18. To describe the epidemiology, classification, pathology, indications for surgery,
and prognosis of common malpositions of the eyelids (eg., blepharoptosis,
trichiasis, distichiasis, essential blepharospasm, entropion, ectropion) and
understand their relationship to secondary diseases of thecornea and conjunctiva
(e.g. exposure keratopathy).
19. To recognize and describe the treatment for a chemical burn (e.g. types of agents,
medical therapy).
20. To recognize and describe the etiologies of hyphema and microhyphema.
21. To describe the etiologies and treatment of superficial punctuate keratitis (e.g. dry
eye, Thygeson's superficial punctate keratopathy), blepharitis, toxicity, ultraviolet
photokeratopathy, contact lens related).

40

22. To describe the symptoms and signs, testing and evaluation for, and treatment of
exposure keratopathy and dry eye (e.g. Schirmer testing).
23. To recognize the anterior segment manifestations of systemic disease (e.g.
Wilson's disease) and pharmacologic side effects (e.g. amiodarone vortex
keratopathy).
24. To recognize, list the differential diagnosis, and evaluate aniridia and other
developmental anterior segment abnormalities (e.g. Axenfeld's, Rieger's, Peters'
anomalies and related syndromes).
25. To recognize and treat pyogenic granuloma.
B. Technical/surgical skills:
1. To perform external examination (illuminated and magnified) and slit lamp
biomicroscopy, including drawing of anterior segment findings.
2. To administer topical anesthesia, as well as special topical stains of the cornea (e.g.
fluorescein dye and Rose Bengal).
3. To perform simple tests for dry eye (e.g. Schirmer test).
4. To perform punctal occlusion (temporary or permanent) or insert plugs.
5. To perform simple corneal sensation testing (e.g. cotton tip swab).
6. To perform tonometry (eg., applanation, tonopen, Schiotz, pneumotonometry).
7. To perform techniques of sampling for viral, bacterial, fungal, and protozoal ocular
infections (eg., corneal scraping and appropriate culture techniques).
8. To perform and interpret simple stains of the cornea and conjunctiva (e.g. culture
techniques, culture media, Gram stain, Giemsa stain, calcofluor white, acid fast).
9. To manage corneal epithelial defects (e.g. pressure patching and bandage contact
lenses).
10. To perform removal of a conjunctival or corneal foreign body (e.g. rust ring).
11. To perform simple pterygium excision.
12. To perform a simple lid laceration repair.
13. To perform a simple corneal laceration repair (e.g. linear laceration not extending
to limbus).
14. To perform epilation.
15. To perform a lateral tarsorrhaphy.
16. To incise/drain or remove a simple chalazion/stye.

41

17. To perform a simple incisional or excisional biopsy of a lid lesion.

18. To perform irrigation of chemical burn to the eye.
19. To treat hyphema and microhyphema (e.g. complications of increased intraocular
pressure and re-bleeding).
JUNIOR RESIDENCY YEAR 2
A. Cognitive Skills:
1. To describe the more complex anatomy, embryology, physiology, pathology,
microbiology, immunology, genetics, epidemiology, and pharmacology of the
cornea, conjunctiva, sclera, eyelids, lacrimal apparatus, and ocular adnexa.
2. To describe the more complex congenital abnormalities of the cornea, sclera, and
globe (e.g. hamartomas and choristomas).
3. To describe, recognize, evaluate, and treat peripheral corneal thinning (e.g.
inflammatory, degenerative, dellen-related, infectious, allergic ).
4. To recognize the common conjunctival neoplasms (e.g. benign, malignant tumors).
5. To recognize and treat less common corneal or conjunctival presentations of
degenerations (e.g. inflamed or atypical pterygium: band keratopathy).
6. To describe the epidemiology, differential diagnosis, evaluation, and management
of Bitot's spots.
7. To describe the epidemiology, differential diagnosis, evaluation, and management
of Thygeson's superficial punctate keratopathy.
8. To understand more complex corneal optics and refraction (e.g. irregular
astigmatism).
9. To correlate the concordance of the visual acuity with the density of media opacity
(e.g. cataract) and to evaluate the etiology of discordance between acuity and
media examination findings.
10. To describe more complex ocular microbiology and describe the differential
diagnosis of more complicated corneal and conjunctival infections (e.g. complex or
atypical bacterial fungal, acanthamoeba, viral, or parasitic keratitis).
11. To describe differential diagnosis, evaluation, and treatment of interstitial keratitis
(e.g. syphilis, viral diseases, inflammation).
12. To describe more complex differential diagnosis of the "red eye" (e.g. autoimmune
and inflammatory disorders causing scleritis, episcleritis, conjunctivitis, orbital
cellulitis).
13. To describe key features of trachoma, including epidemiology, clinical features
and staging, complications (e.g. cicatrization), prevention (e.g. facial hygiene), and
topical and systemic antibiotic treatment (especially in hyperendemic regions) and
surgery (e.g. tarsal rotation).
14. To describe more complex mechanisms of traumatic and toxic injury to the
anterior segment (eg., long-term sequelae of acid and alkali burn, complex lid
42

laceration involving the lacrimal system, full-thickness laceration).

15. To describe the differential diagnosis and the external manifestations of more
complex anterior segment inflammation (e.g. acute and chronic iritis).
16. To describe the more complex principles of ocular pharmacology of anti-infective,
anti-inflammatory and immune modulating agents (e.g. use of topical non-steroidal
and steroidal agents, topical cyclosporine ).
17. To recognize and treat corneal lacerations (perforating and non perforating).
18. To recognize and treat large or atypical pterygia that may require surgery.
19. To describe and treat corneal and conjunctival foreign bodies.
20. To diagnose and treat severe corneal exposure (e.g. lubrication, temporary
tarsorrhaphy)
21. To recognize and treat common and uncommon benign and malignant lid lesions.
22. To recognize and treat common malpositions of the eyelids (e.g. entropion,
ectropion, and ptosis) as they apply to secondary corneal disease.
23. To recognize and treat recurrent corneal erosions.
24. To recognize and treat foreign body, animal, and plant substance injuries.
25. To recognize and treat more complex hyphemas (e.g. surgical indications).
26. To recognize, evaluate, and treat chronic conjunctivitis (e.g. chlamydia, trachoma,
molluscum contagiosum, Parinaud's oculoglandular syndrome, ocular rosacea).
27. To describe the epidemiology, clinical features, pathology, evaluation, and
treatment of ocular cicatricial pemphigoid.
28. To recognize, evaluate, and treat the ocular complications of severe diseases, such
as chronic exposure keratopathy, contact dermatitis, and Stevens-Johnson
syndrome.
29. To describe the epidemiology, clinical features, pathology, evaluation, and
treatment of peripheral corneal thinning or ulceration (e.g. Terrien's marginal
degeneration, Mooren's ulcer, rheumatoid arthritis-related corneal melt).
B. Technical/surgical Skills:

43

1.

To perform more advanced techniques, including keratometry, keratoscopy,

endothelial cell count and evaluation, specular microscopy, and pachymetry.

2.

To perform stromal micropuncture.

3.

To perform application of corneal glue.

4.

To assist in more complex corneal surgery (e.g. penetrating keratoplasty and

phototherapeutic keratectomy).

5.

To perform more advanced tests for dry eye (e.g. modified Schirmer tests,
assessment of tear break up time, fluorescein dye testing, Rose Bengal dye).

6.

To perform a more complex pterygium excision, including conjunctival

grafting.

7.

To perform a more complex lid laceration repair.

8.

To perform manual superficial or lamellar keratectomy.

9.

To perform a more complex corneal laceration repair (e.g. stellate perforating

laceration).

10.

To repair simple lacerations of the lacrimal drainage apparatus (e.g. perform

intubations and simple closure).

SENIOR RESIDENCY
A. Cognitive Skills:
1. To describe the most complex anatomy, embryology, physiology, histopathology,
microbiology, immunology, genetics, epidemiology, and pharmacology of the
cornea, conjunctiva, sclera, eyelids, lacrimal apparatus, and ocular adnexa.
2. To describe the most complex and less common congenital abnormalities of the
cornea, sclera, and globe (e.g. cornea plana, keratoglobus).
3. To recognize common and uncommon corneal and conjunctival neoplasms,
dystrophies and degenerations (e.g. lattice dystrophy).
4. To understand the most complex corneal optics and refraction (e.g. postkeratoplasty).
5. To describe less common and rare ocular infections and describe the differential
diagnosis of the most complicated corneal and conjunctival infections (e.g. amoebas,
leishmaniasis, nematodes).
6. In non-endemic areas, to describe the basic features of onchocerciasIs.
7. In endemic areas to define the etiology, vector (e.g. black fly), and incidence,
diagnostic features (e.g. microfiliariae, keratitis, iritis), diagnosis (e.g. skin snip test),
course and prognosis, treatment (e.g. ivermectin, nodulectomy), and prevention (e.g.
vector control, environmental and behavioral changes) of onchocerciasis.
8. To describe the most complex differential diagnosis of the "red eye" (e.g.
pemphigoid, pemphigus, Stevens-Johnson syndrome).
9. To diagnose and treat the most complex traumatic and toxic injuries to the anterior
segment (eg., total lid avulsion, severe alkali I burn).
10. To describe the differential diagnosis and the external manifestations of the most
complex or uncommon anterior segment inflammations (e.g. syphilitic

44

keratouveitis).
11. To describe the most complex principles of ocular pharmacology of anti-infective,
anti-inflammatory and immune modulating agents (e.g. combination therapies of
antiviral and anti-inflammatory agents).
12. To recognize and treat complex corneal lacerations (e.g. lacerations extending
beyond the limbus).
13. To diagnose and treat the most severe corneal exposure cases (e.g. conjunctival
flap).
14. To understand ocular surface transplantation, including conjunctival autograft/flap,
amniotic membrane transplantation, limbal stem cell transplantation.
15. To understand the surgical indications (e.g. Fuchs' dystrophy, aphakic/pseudophakic
bullous keratopathy), surgical techniques, and recognition and management of
postoperative complications (especially immunologically-mediated rejection) of
corneal transplantation (e.g. penetrating, lamellar).
16. To understand the preoperative assessment, patient selection, surgical management,
and postoperative care of refractive surgical techniques, including keratotomy
(radial, astigmatic), photoablation (photorefractive, phototherapeutic, LASIK),
corneal wedge resection, thermokeratoplasty, intracorneal rings, phakic intraocular
lens and clear lens extraction.
B. Technical/surgical Skills:
1. To perform and interpret the most advanced corneal techniques (e.g. pachymetry,
endothelial microscopy, computerized corneal topography).
2. To understand and perform specialized and complicated contact lens fitting (e.g.
post-keratoplasty).
3. To perform more complex corneal surgery (eg., penetrating or lamellar keratoplasty,
kerato-refractive procedures and phototherapeutic keratectomy).
4. To repair simple entropion and ectropion.
5. To perform a thin conjunctival flap (e.g. Gunderson flap).
6. To perform other complex conjunctival surgery (e.g. autograft, stem cell transplant).
7. To perform basic non-laser refractive surgery techniques (e.g. relaxing keratotomy).
8. To manage and treat more complex neoplasms of the conjunctiva (e.g. carcinoma,
melanoma).

45

GLAUCOMA
JUNIOR RESIDENCY YEAR I
A. Cognitive Skills
1. To describe the epidemiology of primary open angle glaucoma (POAG).
2. To perform evaluation of POAG.
3. To describe the mechanics of aqueous humor dynamics and the anatomy of the
anterior chamber and it angle.
4. To describe basic tonometry and to understand the principles of tonography.
5. To describe optic nerve and nerve fiber layer anatomy in glaucoma.
6. To describe fundamentals of perimetry, including kinetic and automated static
perimetry.
7. To describe principles, indications, basic techniques of gonioscopy, including
normal and abnormal findings.
8. To describe principles of medical management, including indications for and side
effects of treatment options (e.g. topical and systemic medications) for simple
glaucoma (e.g. POAG, primary angle closure glaucoma).
9. To describe and recognize normal tension glaucoma (low tension glaucoma).
10. To describe features of and recognize primary and secondary angle closure
glaucoma and aqueous misdirection.
11. To describe the clinical features of and to recognize hypotony (e.g. Seidel test of
transconjunctival leakage).
12. To list the main results of the major clinical trials in glaucoma (e.g. Glaucoma
Laser Trial, Normal Tension Glaucoma Study, and Advanced Glaucoma
Intervention Study [see Appendix I).
B. Technical Skills:
1. To perform basic tonometry (e.g. applanation, Schiotz, tonopen, airpuff) and
recognize the pitfalls and artificial of the testing.
2. To perform basic gonioscopy (e.g. recognize angle structures, identify angle
closure).
3. To perform stereo examination of the optic nerve, using 78 or 90 diopter or other
lens.
46

4. To interpret manual (e.g. Goldmann) and automated (e.g. Humphery, Octopus,

etc) visual fields in routine glaucoma.
JUNIOR RESIDENCY YEAR 2
A. Cognitive skills:
1. To describe the epidemiology and perform screening for routine and more
advanced primary and secondary open angle glaucoma.
2.

To describe the treatment of disturbances of aqueous humor dynamics.

3.

To describe the more complex etiology for, evaluation of, and treatment of
glaucoma (e.g. recession, inflammatory, steroid-induced, pigmentary,
psuedoexfoliative, phacolytic, neovascular, post-operative, malignant, lens
particle glaucomas; plateau iris; glaucomatocyclitic crisis; iridocorneal
endothelial syndromes; aqueous misdirection).

4.

To describe more advanced tonometric and tonographic (if applicable) methods

(e.g. diurnal curve).

5.

To describe more advanced optic nerve and nerve fiber layer anatomy in primary
and secondary glaucoma and recognize typical and atypical features associated
with glaucomatous cupping (e.g. rim pallor, rapid progression, central acuity
loss, hemianopic or other non-glaucomatous types of visual field loss).

6.

To describe more advanced forms of perimetry (e.g. kinetic and automated static
visual fields) and perimetry strategies (e.g. threshold testing, supra-threshold,
special algorithms).

7.

To describe the principles, indications, and more advanced anatomic findings

and gonioscopic features of primary, and secondary glaucomas (e.g. plateau iris,
appositional closure).

8.

To describe the principles of medical management or more advanced glaucomas

(e.g. advanced POAG, secondary open angle and closed angle glaucomas,
normal tension glaucoma).

9.

To describe the features of, recognize, and treat primary angle closure glaucoma
and aqueous misdirection.

10. To describe the clinical features of, recognize, and treat less common etiologies
of ocular hypotony.
11. To describe the results and apply the conclusions to clinical practice of the major
clinical trials in glaucoma (e.g. Glaucoma Laser Trial, Normal Tension

47

Glaucoma Study, and Advanced Glaucoma Intervention Study; see more

complete list of clinical trials in Appendix I).
12. To recognize and treat the various adult secondary glaucoma.
13. To describe the features of primary infantile and juvenile glaucomas.
14. To describe and apply specific medical treatments of more advanced glaucoma.
15. To describe the principles of laser treatments of glaucoma (e.g. indications,
techniques, and complications, use of various types of laser energy, spot size,
laser wavelengths).
16. To describe the surgical treatment of glaucoma: (e.g. trabeculectomy, combined
cataract and trabeculectomy, setons, and cyclodestructive procedures, including
indications, techniques, and complications).

B. Technical/surgical skills:
1. To perform YAG laser posterior capsulotomy for uncomplicated posterior
capsule opacity.
2. To perform argon or YAG laser peripheral iridotomy for routine angle closure
glaucoma.
3. To perform argon laser trabeculoplasty for uncomplicated glaucoma.
4. To perform cyclophotocoagulation.
5. To perform routine first trabeculectomy with or without anti-metabolities.
6.

To describe and manage a flat anterior chamber.

7. To perform routine revision of filtering blebs.

SENIOR RESIDENCY
A. Cognitive Skills:
1. To describe the features of the most complex, and most advanced forms of
primary and secondary open angle glaucoma.
2.

To describe the mechanics of aqueous humor dynamics in the most advanced and
complex etiologies of glaucoma (e.g. angle recession, combined or multifactorial
glaucoma, traumatic or inflammatory glaucoma, pigmentary glaucoma, pigment
dispersion glaucoma).

48

3.

To apply in clinical practice tonometeric and tonographic methods (e.g. diurnal

curve)) in complicated or atypical cases of glaucoma.

4.

To apply the most advanced knowledge of optic nerve and nerve fiber layer
anatomy and describe techniques, methods, and tools for analyzing the nerve
fiber layer.

5.

To recognize and evaluate atypical or multifactorial glaucomatous cupping (e.g.

rim pallor).

6.

To describe, interpret, and apply the results of the most complex and advanced
forms of perimetry, including, special kinetic and automated static perimetry
strategies (e.g. special algorithms) in atypical or multifactorial glaucoma.

7.

To describe the principles and indications, and apply to clinical practice the
findings of gonioscopy in the complex primary and secondary glaucomas.

8.

To describe the principles of medical management of the advanced and complex

glaucoma (e.g. advanced POAG previously treated with medicine, laser or
surgery; secondary glaucomas).

9.

To describe, recognize, and treat the most advanced cases of primary open angle
glaucoma (e.g. monocular patients, repeat surgical cases), normal tension
glaucoma, and secondary glaucomas (e.g. inflammatory glaucoma, angle
recession).

10. To describe the features of, recognize, and treat the most advanced cases of
primary angle closure glaucoma and complex glaucomas (e.g. post-operative
cases, secondary angle closure, aqueous misdirection).
11. To describe the clinical features of, recognize and treat common and uncommon
etiologies of ocular hypotony (e.g. choroidal detachment, leaking trabeculectomy
bleb).
12. To describe the results, apply the conclusions, and critically analyze the major
clinical trials in glaucoma (e.g. Glaucoma Laser Trial, Normal Tension
Glaucoma Study, and Advanced Glaucoma Intervention Study), as well as
describe and use other publications in the management of glaucoma patients (see
Appendix I).
13. To recognize and treat uncommon adult secondary glaucomas.
14. To describe the features of and treat or refer the primary infantile and juvenile
glaucomas.

49

15. To describe and apply specific medical treatments in the most complex and most
advanced glaucoma cases (e.g. refractory glaucoma, monocular patients, noncomplaints patients).
16. To describe the principles, indications, and complications of laser treatment of
more advanced complex glaucoma (repeat procedures).
17. To describe the more advanced surgical treatment of glaucoma: (e.g.
trabeculectomy, combined cataract and trabeculectomy, setons; and
cyclodestructive procedures, including indications, techniques, and
complications).
B. Technical/surgical Skills:
1. To perform YAG or argon laser procedures in glaucoma patients (e.g. monocular
patient, repeat laser, vitreous lysis, suture lysis).
2. To perform laser peripheral iridotomy more advanced glaucoma (e.g. monocular
patient, acute angle closure, hazy cornea).
3. To perform laser treatment (e.g. argon laser trabeculoplasty, iridoplasty) for
more advanced glaucoma cases (repeat treatments, monocular patient).
4. To perform cyclophotocoagulation for more advanced cases (e.g. monocular).
5. To perform routine and repeat trabeculectomy with or without antimetabolites.
6. To describe, manage, and treat surgically, if necessary, a flat anterior chamber.
7. To perform more advanced techniques for the revision of filtering blebs (e.g.
failing bleb, leaking bleb).
8. To recognize and treat glaucoma surgery bleb complications.

NEURO-OPHTHALMOLOGY
JUNIOR RESIDENCY YEAR 1
A. Cognitive Skills:
1. To describe the neuro-anatomy of the visual pathways.
2. To describe the neuro-anatomy of the cranial nerves
3. To describe the pupillary and accommodative neuro-anatomy.
4. To describe ocular motility and related neuronal pathways.

50

5. To describe the typical features, evaluation, and management of the most

common optic neuropathy (arteritic and non-arteritic), toxic or nutritional optic
neuropathy, Lebers
hereditary optic
neuropathy, ethambutol toxicity,
neuroretinitis, and public healt and compressive, inflammatory, infiltrative and
traumatic optic neuropathies).
6. To describe the typical features, evaluation, and management of the most
common ocular motor neuropathies (e.g. third, fourth, sixth nerve palsy).
7. To describe the typical features of cavernous sinus and superior orbital fissure
syndromes (e.g. infectious, vascular, neoplastic, inflammatory etiologies).
8. To describe the typical features, evaluation, and management of the most
common causes of nystagmus (e.g. congenital motor and sensory, downbeat,
upbeat, gaze-evoked, drug-induced).
9. To describe the typical features, evaluation, and management of the most
common papillary abnormalities (e.g. relative afferent papillary defect, anisocoria,
Horner syndrome, third nerve palsy, Adies tonic pupil).
10. To describe the typical features, evaluation, and management of the most
common visual field defects (e.g. optic nerve, optic chiasm, optic radiation,
occipital cortex).
11. To describe the epidemiology, clinical features, evaluation, and management of
ocular myasthenia gravis.
12. To describe the epidemiology, clinical features, evaluation, and management of
carotid-cavernous fistula.
13. To describe the epidemiology, differential diagnosis, evaluation and management
of congenital optic nerve abnormities (e.g. optic pit, disc coloboma, papillo-renal
syndrome, morning glory syndrome, tilted disc, optic nerve hypoplasia,
myelinated nerve fiber layer, melanocytoma, disc drusen, Bergmeisters papilla).
B. Technical Skills:
1. To perform a basic papillary examination
a. To describe the indications for and perform basic pharmacologic pupillary
testing for Horner syndrome, pharmacologic dilation, and Adies pupil.
b. To list the differential diagnosis of aniscocoria (e.g. sympathetic or
parasympathetic lesion, physiologic).
c. To describe, detect, and quantitate a relative afferent pupillary defect.

51

d. To list the causes for light-near dissociation (e.g. Argyll Robertson pupils,
diabetic neuropathy, tonic pupil).
2. To perform a basic ocular motility examination
a. To assess ocular alignment using simple techniques (e.g. Hirschberg,
Krimsky).
b. To describe and perform basic cover/uncover testing for tropia.
c. To describe and perform alternate cover testing for phoria.
d. To perform simultaneous prism and cover testing.
e. To perform measurement of deviations with prisms.
f. To describe the indications for and apply fresnel and grinding prisms.
g. To describe the indications for and to perform forced duction test.
h. To perform an assessment of saccade accuracy and pursuit and optokinetic
testing.
i. To perform a measurement of eyelid function (e.g. levator function, lid
position).
3. To describe the indications for visual field testing and to perform and interpret
perimetry studies
a. To perform confrontational field testing (static and kinetic, central and
peripheral, red and white targets).
b. To perform and interpret a tangent screen test.
c. To describe the indications for and perform basic Goldmann perimetry, and
interpret results.
d. To describe the indications for and perform automated perimetry, and
interpret results.
4. To perform basic direct, indirect, and magnified ophthalmoscopic examination of
the optic disc (e.g. recognize optic disc swelling, optic atrophy, neuroretinitis).
5. To describe the anatomy and indications for, order appropriately, and interpret
basic radiology studies of the brain and orbits, demonstrating the ability to
communicate with radiologists in order to maximize both choice of proper
diagnostic test and accuracy of interpretation.

52

6. To describe the indications for and interpret basic echography of orbits.

JUNIOR RESIDENCY YEAR 2
A. Cognitive Skills:
1. To describe typical and atypical features, evaluation, and management of the most
common optic neuropathies (e.g. papilledema, optic neuritis, ischemic, inflammatory,
infectious, infiltrative, compressive, and hereditary optic neuropathies).
2. To describe typical and atypical features, evaluation, and management of the more
complex supranuclear and internuclear palsies and less common ocular motor
neuropathies (e.g. progressive supranuclear palsy and internuclear ophthalmoplegia).
3. To describe typical and atypical features, evaluation, and management of the more
complex and less common forms of nystagmus (e.g. rebound, convergence,
retraction).
4. To describe typical and atypical features, evaluation, management of the more
complex and less common pupillary abnormalities (e.g. light near dissociation,
pharmacologic miosis).
5. To describe typical and atypical features, evaluation, and management of the more
complex and less common visual field defects (e.g. lateral geniculate, monocular
temporal crescent).
6. To describe more advanced aspects of visual field indications, selection, and
implementation (e.g. artifacts of automated perimetry testing and thresholding
strategies).
7. To describe neuro-ophthalmic aspects of common systemic diseases (e.g.
hypertension, diabetes, thyroid disease, myasthenia gravis, temporal arteritis,
systemic infections and inflammation).
8. To describe neuro-ophthalmologic findings in trauma (e.g. traumatic optic
neuropathy, traumatic brain injury).
9. To describe typical features of inherited neuro-ophthalmologic diseases (eg., Lebers
hereditary optic neuropathy, autosomal dominant optic atrophy, spinocerebellar
degenerations).
10. To recognize, evaluate, and treat ocular myasthenia gravis.

B. Technical Skills:

53

1. To describe the indications for, administer, and interpret the results of

intravenouos edrophonium (Tensilon) and prostigmine tests for myasthenia
gravis.
2. To perform a detailed cranial nerve evaluation (eg., testing of trigeminal and
facial nerves functions).
3. To describe the more advanced interpretation of neuro-radiologic images (eg.
Indications and interpretation of orbital tumors, thyroid eye disease, pituitary
adenoma, optic nerve glioma, optic nerve sheath meningioma).
4. To describe the evaluation, management, and specific testing (eg., stereopsis,
mirror test, red-green testing) of patients with functional visual loss (eg.,
recognize non-organic spiral or tunnel visual fields).
5. To describe the indications for, to perform, and lo list the complications of
temporal artery biopsy.
SENIOR RESIDENCY
A. Cognitive Skills:
1. To describe typical and atypical features, evaluation, and management of the
most advanced and least common optic neuropathies (e.g. chronic or recurrent
optic neuritis, and posterior ischemic, autoimmune, toxic/nutritional).
2. To describe typical and atypical features, evaluation, and management of the
most complex and least common ocular motor neuropathies and their mimics
(e.g. progressive supranuclear palsy).
3. To describe typical and atypical features, evaluation, and management of the
most complex and least common forms of nystagmus (e.g. surgical treatment
options, using the null point in either prism or surgical therapy).
4.

To describe typical and atypical features, evaluation, and management of the

most advanced and least common pupillary abnormalities ((e.g. pupil findings in
coma, transient pupillary phenomenon).

5. To describe typical and atypical features, evaluation, and management of the

most complex and least common visual field defects (e.g. combination or
bilateral lesions, cortical visual impairment).
6. To describe the most advanced aspects of visual field indications, selection, and
interpretation (e.g. variability in automated perimetry, application of specific
testing and thresholding strategies for different patient populations with different
neuro-ophthalmic conditions, different testing abilities (e.g. young or old age,
mental status, hand-eye coordination, reaction time).

54

7. To describe, evaluate, and treat the neuro-ophthalmic aspects of systemic

diseases (e.g. malignant hypertension, diabetic papillopathy, toxicity of systemic
medications, pseudotumor cerebri).
8. To describe, evaluate, and treat the neuro-ophthalmologic manifestations of
trauma (e.g. corticosteroid or surgical therapy in traumatic optic neuropathy).
9. To describe, evaluate, and provide appropriate genetic counseling for neuroophthalmologic diseases (Lebers hereditary optic neuropathy, chronic
progressive external ophthalmoplegia, von Hippel-Lindau syndrome).
10. To recognize, evaluate, and treat (or refer more complex forms of nystagmus.
11. To recognize, evaluate, treat (or refer) transient monocular or binocular visual
loss.
B. Technical Skills:
1. To perform and interpret the results of the intravenous edrophonium (Tension)
and prostigmine tests for myasthenia gravis, and to recognize and treat the
complications of the procedures.
2. To perform and interpret the complete cranial nerve evaluation (e.g. testing of and
facial nerve function) and basic neurologic exam in the context of neuroophthalmic localization and disease.
3. To interpret neuro-radiologic images in neuro-ophthalmology (e.g. interpretation
of orbital imaging for orbital pseudotumor and tumors, thyroid eye disease,
intracranial imaging modalities and strategies for tumors, aneurysms, infection,
inflammation, and ischemia), and to appropriately discuss, in advance of testing,
the localizing clinico-radiologic features, with the neuro-radiologist in order to
obtain the best study and interpretation of the results.
4. To recognize patients with functional visual loss (non-organic visual loss) and
provide appropriate counseling and follow-up.

OPHTHALMIC HISTOPATHOLOGY
JUNIOR RESIDENCY YEAR 1
A. Cognitive Skills:
1. To perform a basic pupillary examination.

55

2. To describe basic ocular anatomy and to identify the history of the major
structures of the eye (e.g. conjunctiva, sclera, cornea, anterior chamber angle, iris,
ciliary body, lens, vitreous, retina, retinal pigment epithelium, choroids, optic
nerve).
3. To describe basic patho-physiology of the common disease process of the eye and
to identify the major hisotlogic findings of each (e.g. infection, inflammation,
neoplasm).
4. To identify the histology of important intraocular and adnexal diseases (e.g.
endophthalmitis, retinoblastoma, choroidal melanoma, microbial keratitis).

B. Technical skills: (for an ocular pathology laboratory, as available)

1. To describe appropriate steps in the basic handling and processing of gross
specimens in the ocular pathology laboratory (e.g. basic preparation of the
specimen) and to demonstrate proficiency in these steps in the laboratory.
2. To describe appropriate information necessary for communication with the
pathologist regarding special handling of specimens for specials stains or studies.
3. To describe indications for frozen sections in ocular pathology.
4. To perform cutting and gross examination of whole globes.
5. To participate under supervision in the
ophthalmology specimens from active cases.

microscopic

examination

of

JUNIOR RESIDENCY YEAR 2

A. Cognitive skills
1. To describe more advanced ocular anatomy and to identify the histology of the
major and minor structures of the eye (e.g. conjunctival glands, normal pigment,
common variants).
2. To describe more advanced pathophysiology of the disease processes of the eye
and to identify the major histologic findings of each (e.g. fungal keratitis, skin and
adnexal neoplasm, and less common intraocular tumors).
3. To identify histology of the less common but potentially vision-or life threatening
intraocular and adnexal diseases (e.g. temporal arteritis, fungal keratitis
extraocular spread of intraocular tumor, metastatic disease to the eye).

56

4. To describe more advanced techniques in ocular histopathology (e.g. electron

microscopy, immunohistochemistry, flow cytometry, tumor-free margins).

B.Technical Skills:
1. To describe appropriate steps in the more advanced handling and special
processing of gross specimens in the ocular pathology laboratory.
2. To describe specific indications for special handling and to communicate to the
pathologist the necessity for special handling of specimens for special stains or
studies (e.g. electron microscopy, immunohistochemistry, flow cytometry).
3. To describe indications and to perform and prepare a biopsy specimen for frozen
section in ocular pathology.
4. To perform preparation of a basic histologic specimen for review by the
pathologist.
5. To participate as an at-the-elbow observer during microscopic examination of
active ophthalmology cases and to perform microscopic examination of
specimens with and without direct supervision.

SENIOR RESIDENCY
A. Cognitive Skills:
1. To describe the most advanced ocular anatomy and to identify histology of the
major and minor structures of the eye and their less common variants (e.g. pars
plana cysts, iris heterochromia, cobblestone degeneration of the retina).
2. To describe the most advanced, less common or more complex path physiology of
the disease process of the eye and to identify major histologic findings of each
(e.g. inflammatory pseudotumor, lymphoma, artifacts of processing).
3. To identify the histology of the common but potentially vision- or life-threatening
intraocular and adnexal diseases (eg., healed giant cell arteritis, uncommon
benign and malignant neoplasms).

B. Technical skills:
1. To describe and to perform appropriate steps for handling gross specimens in the
ocular pathology laboratory.

57

2. To describe specific indications for special handling and to communicate to the

pathologist the necessity for special handling of specimens for special stains or
studies (e.g., electron microscopy, immunohistochemistry, flow cytometry).
3. To describe indications and to perform and prepare a biopsy specimen for frozen
section in ocular pathology.
4. To perform preparation of a basic histologic specimen for review by the
pathologist.
5. To participate as an at-the-elbow observer during microscopic examination of
active ophthalmology cases and to perform microscopic examination of a
specimen with and without direct supervision.

OCULOPLASTIC SURGERY AND ORBIT

JUNIOR RESIDENCY YEAR 1
A. Cognitive Skills:
1. To describe basic eyelid, lacrimal, and orbital anatomy and physiology (eg., eyelid,
orbicularis, orbital structures, meibomian glands, lacrimal glands, glands of Zeiss,
Whitnall's ligament, Muller's muscle, Lockwood's ligament. canaliculi, puncta,
orbital bones, orbital foramina, paranasal sinuses, annulus of Zinn, arterial and
venous vascular supply, lymphatics, nerves, extraocular muscles).
2. To describe basic mechanisms and indications for treatment of eye lid, orbital, and
lacrimal trauma.
3. To describe epidemiology, clinical features, evaluation, and management of fetal
alcohol syndrome.
4. To perform pre-operative and post-operative assessment of patients with common
oculoplastic disorders.
5. To recognize simple orbital trauma (e.g. orbital foreign body, retrobulbar
hemorrhage).
6. To recognize and treat floppy eyelid syndrome.
7. To recognize and treat simple trichiasis.
8. To recognize blepharospasm and hemifacial spasm.
9. To describe the differential diagnosis of common orbital tumors in children and
adults.

58

10. To describe the differential diagnosis of lacrimal gland mass (e.g. inflammatory,
neoplastic, congenital, infectious).
11. To identify normal orbital anatomy on imaging studies (e.g. magnetic resonance
imaging, computed tomography, ultrasound).
12. To describe the differential diagnosis of proptosis in children and adults.
13. To describe techniques and complications of minor operating room procedures
(e.g. incision and drainage of chalazia, excision of small eyelid lesions).
14. To describe typical features of orbital cellulitis.
B. Technical/surgical Skills:
1. To describe indications for and to perform the basic office examination techniques
for the most common oculoplastic and orbital abnormalities.
2. To identify indications for and to perform the basic assessment of the eyelids (e.g.
eversion, double eversion) and eyebrows (e.g. margin to reflex distance, lid crease,
levator function, eyelid/brow malpositions ).
3. To identify indications for and to perform the basic lacrimal assessment (e.g. dye
testing, punctal dilation, lacrimal probing, canalicular probing, lacrimal irrigation).
4. To identify indications for and to perform the basic assessment of the orbit (e.g.
Hertel exophthalmometry, inspection, palpation, auscultation).
5. To identify indications for and to perform the basic socket assessment (e.g. types of
implants, socket health).
6. To perform minor lid procedures (e.g. removal of benign eyelid skin lesions,
chalazion curretage or excision, conjunctival biopsy).
7. To treat complications of minor operating room procedures (e.g. incision and
curretage of chalazia, excision of small eyelid lesions).
8. To perform punctal plug insertion or removal.
9. To recognize and treat trichiasis (e.g. epilation, cryotherapy, surgical therapy).
10. To perform a simple enucleation or evisceration under supervision.
JUNIOR RESIDENCY YEAR 2
A. Cognitive Skills:
1. To describe more advanced eyelid, lacrimal, and orbital anatomy and physiology
(e.g. lacrimal apparatus, orbital vascular anatomy).

59

2. To describe the genetics (where known), clinical features, evaluation, and

treatment of congenital eyelid deformities (e.g. coloboma, distichiasis, epicanthus,
telecanthus, blepharophimosis, ankyloblepharon, epiblepharon, euryblepharon,
and Goldenhar, Treacher-Collins,Waardenburg syndromes).
3. To describe the clinical features, evaluation and management of congenital orbital
deformities (e.g. synophthalmia, anophthalmia, microphthalmia, cryptophthalmia,
hypertelorism, hypotelorism).
4. To describe the genetics, clinical features, evaluation, and management of
common craniosynostoses and other congenital malformations (eg.,Crouzon,
Apert).
5. To treat (or refer for treatment) congenital eyelid abnormalities (see Basic Level,
above).
6. To perform pre-operative and post -operative assessment of patients with simple
and more serious oculoplastic disorders (e.g. multidisciplinary procedures).
7. To describe the mechanisms and indications for treatment of more advanced
eyelid, orbital, and lacrimal trauma (e.g. full thickness lid laceration, chemical
burns to the face).
8. To describe features of, recognize, evaluate, and treat more complicated cases of
nasolacrimal duct obstruction, canaliculitis, dacyrocystitis, acute and chronic
dacryoadenitis, preseptal cellulitis, and orbital cellulitis.
9. To recognize, evaluate and treat thyroid ophthalmopathy (e.g. epidemiology,
symptoms and signs, orbital imaging, differential diagnosis, surgical, medical, and
radiation indications, side effects of treatment).
10. To recognize, evaluate and treat orbital inflammatory pseudotumor (e.g.
epidemiology, symptoms and signs, orbital imaging, differential diagnosis, biopsy
indications, choice of treatments).
11. To recognize, treat, or refer blepharospasm or hemifacial spasm.
12. To recognize less common orbital tumors (e.g. metastatic lesions).

15. Technical/surgical Skills:

1.

To describe indications for and to perform more advanced examination

techniques for less common oculoplastic and orbital abnormalities (e.g.
measurement of levator function, orbital ultrasound intepretation).

2. To identify indications for and to perform more advanced assessment of eyelids

and eyebrows (e.g. hypoglobus, facial asymmetry, brow ptosis).
3. To identify indications for and to perform more advanced lacrimal assessment
(e.g. interpretation of dye testing, canalicular probing in trauma).

60

4. To identify indications for and to perform more advanced assessment of the orbit
(e.g. enophthalmos, interpretation of orbital ultrasound in common conditions).
5. To identify indications for and to perform more advanced socket assessment (e.g.
extrusion of implants, anophthalmic socket complications).
6. To perform more complicated minor lid procedures (e.g. larger benign skin
lesions) or surgery (e.g. recurrent or multiple chalazion).
7. To recognize the indications and complications and to perform more complex
minor operating room or limited operating room procedures (e.g. incision and
drainage of recurrent or larger chalazia, excision of moderate sized benign eyelid
lesions).
8. To recognize and treat orbital trauma (e.g. intraorbital foreign body, retrobulbar
hemorrhage, fracture).
9. To identify common orbital pathology (e.g. orbital fractures, orbital tumors) on
imaging studies (e.g. magnetic resonance imaging, computed tomography,
ultrasound).
10. To treat common presentations of preseptal or orbital cellulitis.
11. To describe, recognize the indications and complications, and to perform the basic
lacrimal procedures below:
a. Lacrimal drainage testing (irrigation, dye disappearance test)
b. Lacrimal intubation
c. Dacryocystorhinostomy (external)
SENIOR RESIDENCY
A. Cognitive Skills:
1. To describe the most advanced eyelid, lacrimal, and orbital anatomy and
physiology.
2. To evaluate and to treat simple and more advanced eyelid, orbital, and lacrimal
trauma (eg., full thickness lid laceration, chemical bums to the face).
3. To perform pre-operative and post-operative assessment and coordination of care
of patients with more advanced or complex oculoplastic disorders (e.g.
systemically ill patient, multi-disciplinary procedures).
4. To describe the etiology, evaluation, and medical and surgical treatment of the
following eyelid diseases
a. Complex ectropion (e.g. congenital, paralytic, involutional, cicatricial,
mechanical, allergic).
b. Complex entropion (e.g. involutional, cicatricial, spastic, congenital).

61

c. Complex myogenic
ophthalmoplegia).

ptosis

(e.g.

chronic

progressive

external

d. Complex differential diagnosis for dermatochalasis (e.g. blepharochalasis ).

e. Benign, pre-malignant, or malignant eyelid tumors (e.g. papilloma,
keratoacanthoma, seborrheic keratosis, epidermal inclusion cyst, molluscum
contagiosum, verruca vulgaris, actinic keratosis, basal cell carcinoma,
squamous cell carcinoma, sebaceous cell carcinoma, melanoma).
f. Single or recurrent inflammatory lesions (e.g. recurrent chalazion or its
mimics).
g. Facial dystonia (e.g. blepharospasm, hemifacial spasm). Facial nerve palsy
with exposure keratopathy (e.g. tarsorrhaphy, gold weights).
h. Facial dystonia (e.g. blepharospam, hemifacial spasm).
i. Complex lid and orbital trauma cases.

B. Technical/surgical Skills:
1. To describe the indications for and to perform more complicated and advanced
"in office" examination techniques for the less common but important
oculoplastic and orbital abnormalities.
2. To perform preoperative and intraoperative assessment of the eyelids and eyebrows
(e.g. intraoperative adjustments).
3. To perform more advanced lacrimal assessment (e.g. intraoperative and
postoperative testing, more complex trauma to lacrimal system).
4. To recognize and treat more complex or difficult socket-related problems and
complications (e.g. extrusion of implants, anophthalmic socket complications).
5. To perform more complicated lid procedures (e.g. larger benign, recurrent, or
multiple skin lesions.
6. To describe management of. and treat lacrimal system abnormalities, including
a. More complex congenital disorders (e.g. canalicular stenosis)
b. More complex acquired disorders and their treatment (e.g. conjunctivodacryocystorhinostomy with Jones tube)
c. Complex moderate trauma (e.g. requiring lacrimal intubation)

62

7.

To recognize typical and atypical features and to describe the differential

diagnosis, clinical features, and treatment of more complicated orbital disease,
including
a. More complex orbital infections (e.g. preseptal and orbital cellulitis,
mucormycosis, aspergillosis)
b. Congenital tumors (e.g. dermoid)
c. Fibro-osseus disorders and tumors (e.g. fibrous dysplasia, osteoma,
chondrosarcoma, osteosarcoma, Paget's disease)
d. Vascular tumors (e.g. capillary hemangioma, cavernous hemangioma,
hemangiopericytoma, lymphangioma, Kaposi's sarcoma)
e. Xanthomatous tumors (e.g. xanthelasma, juvenile xanthogranuloma)
f. Lacrimal gland tumors (e.g. benign mixed tumor, adenoid cystic carcinoma,
malignant mixed tumor, lymphoma)
g. Neural tumors (e.g. optic nerve glioma, meningioma, neurofibromatosis,
neuroblastoma)
h. Rhabdomyosarcoma
i. Orbital pseudo tumor
j. Lymphoid lesions (e.g. lymphoid hyperplasia, lymphoma, leukemia)
k. Thyroid-related orbitopathy
l. Metastatic tumors (e.g. from breast, lung, prostate, colon, melanoma)
m. Trauma (e.g. orbital fractures, traumatic optic neuropathy)
n. Anophthalmic socket - implant exposure, volume augmentation

8. To describe, recognize the indications and complications, and to perform the eyelid
procedures listed below
b.
c.
d.
e.
f.

a. Basic biopsy techniques

Lateral tarsal strip
Specialized lid suture procedures (e.g. Quickert sutures)
Medial spindle
Retractor reinsertion
Levator advancement
63

g. Eyelid laceration/margin repair

h. Tarsorrhaphy
i. Lateral canthoplasty (canthotomy and cantholysis)
j. Blepharoplasty
k. Facial nerve palsy - gold weight placement in the lid
l. Simple eyelid reconstruction
m. Orbital approaches and incisions (e.g. Kronlein, CaldweIl Luc,
transconjunctival, transnasal)
9. To describe, recognize the indications and complications, and perform basic
orbital skills and procedures
a. Anterior orbitotomy for tumor biopsy/excision
b. Orbital floor fracture repair
10. To describe the indications for and to interpret CT and MRI scans (e.g. orbital
trauma, orbital lesions and tumors).
11. To perform simple botulinum toxin injections (e.g. blepharospasm).
12. To identify more advanced orbital pathology (e.g. complex orbital fractures,
orbital tumors) on imaging studies (e.g. magnetic resonance imaging, computed
tomography, ultrasound).

PEDIATRIC OPHTHALMOLOGY AND STRABISMUS

JUNIOR RESIDENCY YEAR 1
A. Cognitive Skills:
1. To describe basic examination techniques for strabismus (e.g. ductions and
versions, cover and uncover testing, alternate cover testing, prism cover testing).
2. To describe basic visual development and visual assessment of the pediatric
ophthalmology patient (e.g. central, steady, maintained fixation; illiterate E, Allen
cards, Landholt C charts).
3. To describe basic anatomy and physiology of strabismus (e.g. innervation of
extraocular muscles, primary actions, comitant and incomitant deviations,
overaction and underaction, restrictive and paretic, saccades and pursuit
movements).
4. To describe basic sensory adaptations for binocular vision (e.g. normal and
anomalous retinal correspondence, suppression, horopter, Panum's area, fusion,
stereopsis).
5. To describe and recognize pseudo-strabismus.

64

6. To describe different etiologies of amblyopia (e.g. deprivation, ametropic,

strabismic, anisometropic, organic).
7. To describe etiologies of esotropia (e.g. congenital, comitant and incomitant,
accommodative and non-accommodative, decompensated, sensory, neurogenic,
myogenic, neuromuscular junction, restrictive, nystagmus blockage syndrome,
spasm of the near, monofixation syndrome, consecutive).
8. To describe etiologies of exotropia (e.g. congenital, comitant and incomitant,
decompensated, sensory, neurogenic, myogenic, neuromuscular junction,
restrictive, basic, divergence excess, exophoria, convergence insufficiency).
9. To describe various strabismus patterns (e.g. A or V pattern).
10. To describe aetiologies, evaluation, and management of vertical strabismus (e.g.
neurogenic, myogenic, neuromuscular junction, oblique overaction, dissociated
vertical deviation, restrictive).
11. To describe non-surgical treatment of strabismus.
12. To describe different forms of childhood nystagmus.
13. To describe features, classification, and treatment indications for retinopathy of
prematurity.
14. To describe etiologies and types of pediatric cataracts.
15. To describe and recognize ocular findings in child abuse (e.g. retinal hemorrhages)
and appropriately refer to child protective services or other authorities.
16. To describe common hereditary or congenital ocular motility or lid syndromes
(e.g. Duane syndrome, Marcus Gunn jaw winking, Brown syndrome).
17. To describe typical features of retinoblastoma.
18. To describe basic features of dyslexia.
19. To describe basic evaluation of decreased vision in infants and children (e.g.
retinopathy of prematurity, hereditary retinal disorders, congenital glaucoma,
measles, vitamin A deficiency).
20. To describe identifiable congenital ocular anomalies (e.g. microphthalmia,
persistent fetal vasculature).
21. To describe ocular findings in inherited, metabolic disorders
a. Mucopolysaccharidoses (e.g. Hurler syndrome, Scheie syndrome, Hunter
syndrome, San Fillipo syndrome, Morquio syndrome, Sly syndrome).
b. Lipidoses (e.g. Tay-Sachs disease, Sandhoff, Niemann-Pick, Krabbe's,
Gaucher's, Fabry's, metachromatic leukodystrophy).
c. Aminoacidurias (e.g. homocystinuria, cystinosis, Lowe, Zellweger).

65

22. To describe ocular findings in chromosomal abnormalities (e.g. Trisomy 21,

Trisomy 13, Trisomy 18, Short arm 11 deletion, Long arm 13 deletion, Cri du
Chat, Turner).
B. Technical Skills:
1. To perform an extraocular muscle examination based on knowledge of the
anatomy and physiology of ocular motility.
2. To assess ocular motility using ductions and versions testing.
3. To apply Hering's and Sherringtons laws.
4. To perform basic measurement of strabismus (e.g. Hirschberg, Krimsky, cover
testing, prism cover testing, simultaneous prism cover test, alternate cover testing,
Parks-Bielschowsky three-step test, Lancaster red-green test, Maddox rod testing,
double Maddox rod testing).
5. To perform assessment of vision in the neonate, infant, and child.
6. To recognize and apply in a clinical setting the following skills in the ocular
motility examination (simple, advanced)
a. Stereoacuity testing
b. Accommodative convergence/accommodation ratio (e.g. heterophoria method,
gradient method)
c. Tests of binocularity and retinal correspondence
d. Cycloplegic refraction (retinoscopy)
e. Anterior and posterior segment examination
f. Basic and advanced measurement of strabismus
g. Cover test measurement
h. Assessment of vision
i)
Teller acuity cards
ii)
Fixation preference test
iii)
Standard subjective visual acuity tests
iv)
Induced tropia test
7. To assist a primary surgeon in performing extraocular muscle surgery including:
a. Recession
b. Resection
c. Muscle weakening (e.g. tenotomy) and strengthening (e.g. tuck) procedures
d. Transposition
e. Use of adjustable sutures
JUNIOR RESIDENCY YEAR 2
A. Cognitive Skills:
1. To describe basic and more advanced strabismus examination techniques (e.g.
combined vertical and horizontal prism cover testing, double Maddox rod
testing).
2. To describe basic and more advanced visual development and visual
assessment of the pediatric ophthalmology patient (e.g. blink, measures of
fixation and following behavior, objective measures of visual acuity).

66

3. To describe more advanced anatomy and physiology of strabismus (e.g.

torsion, tertiary actions, consecutive deviations).
4. To describe more advanced sensory adaptations (e.g. anomalous head position).
5. To describe basics of binocular sensory testing (e.g. Titmus stereo-testing,
Randot stereo testing, Worth 4-dot, Bagolini lenses, after image testing).
6. To describe and to recognize different etiologies of amblyopia.
7. To describe and recognize etiologies of esotropia.
8. To describe and recognize etiologies of exotropia.
9. To describe and recognize various strabismus patterns (e.g. A or V pattern).
10. To describe and recognize the etiologies of vertical strabismus.
11. To describe and utilize the non-surgical treatment of strabismus and amblyopia
(e.g. patching, atropine penalization, Fresnel and grind-in prism therapy).
12. To describe and recognize the different forms of childhood nystagmus (e.g.
sensory, motor, congenital, acquired).
13. To describe and recognize retinopathy of prematurity (e.g. stages, treatment
indications).
14. To describe and recognize etiologies and types of pediatric cataracts (e.g.
congenital, traumatic, hereditary, idiopathic).
15. To describe and recognize less common hereditary or malformative ocular
anomalies and syndromes (e.g. Mobius, Goldenhar syndrome).
16. To describe and recognize typical features of retinoblastoma (e.g. differential
diagnosis, evaluation, treatment indications).
17. To describe the main features of dyslexia and its relationship to vision.
18. To describe basic evaluation and differential diagnosis of decreased vision in
infants and children (e.g. retinal and optic nerve etiologies, amblyopia).
19. To describe recognizable causes of blindness in infants (e.g. albinism, optic
nerve hypoplasia, achromatopsia, Leber's congenital amaurosis, retinal
dystrophy, congenital optic atrophy).
20. To describe etiology, evaluation, and management of congenital infections (e.g.
toxoplasmosis, rubella, cytomegalovirus, syphilis, herpes).
21. To describe and recognize the common causes of pediatric uveitis.
B. Technical Skills:
1. To perform a more advanced extraocular muscle examination based on knowledge
of the anatomy and physiology of ocular motility.
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2. To assess more advanced ocular motility problems (e.g. bilateral or multiple cranial
neuropathy, myasthenia gravis, thyroid eye disease).
3. To apply Hering's and Sherrington's laws in more advanced cases (e.g.
pseudoparesis of the contralateral antagonist, enhancement of ptosis in myasthenia
gravis)
4. To perform more advanced measurements of strabismus (e.g. double Maddox rod
testing, Lancaster red green testing, synoptophore or amblyoscope).
5. To perform assessment of vision in more difficult strabismus patients (e.g.
uncooperative child, mentally impaired, nonverbal or preverbal).
6. To perform basic extraocular muscle surgery
b. To exercise surgical judgement for the indications and contraindications
for strabismus surgery
c. To perform pre-operative assessment, intraoperative techniques and to
describe intraoperative and post-operative complications of strabismus
surgery
d. To perform the following strabismus surgeries
i)
Recession
ii)
Resection
iii)
Muscle weakening (e.g. tenotomy) and strengthening (e.g. tuck)
procedures
iv)
Transposition
v)
Use of adjustable sutures
e. To manage the complications of strabismus surgery (e.g. slipped muscle,
anterior segment ischemia).
SENIOR RESIDENCY
A. Cognitive Skills:
1. To describe and perform the most advanced strabismus examination
techniques (e.g. complicated prism cover testing in multiple cranial
neuropathy, patients with nystagmus, dissociated vertical deviation,
double Maddox rod testing).
2. To perform the most advanced techniques for assessment of visual
development in complicated or non-cooperative pediatric ophthalmology
patients (e.g. less common objective measures of visual acuity,
electrophysiologic testing).
3. To apply the most advanced knowledge of strabismus anatomy and
physiology (e.g. spiral of Tillaux, secondary and tertiary actions, spread of
comitance) in evaluation of patients.
4. To describe clinical application of the most advanced sensory adaptations
(e.g. anomalous head position, anomalous retinal correspondence).

68

5. To recognize and treat the most complicated etiologies of amblyopia (e.g.

refraction non-compliance, patching failures, pharmacologic penalization).
6. To recognize and treat the most complex etiologies of esotropia (e.g.
optical, prism-induced, post-surgical/consecutive).
7. To recognize and treat the most complex etiologies of exotropia (e.g.
supranuclear, paralytic pontine exotropia, consecutive).
8. To recognize and treat the most complex strabismus patterns (e.g. aberrant
regeneration, post-surgical, thyroid ophthalmopathy and myasthenia
gravis).
9. To recognize and treat the most complex etiologies of vertical strabismus
(e.g. skew deviation, post-surgical, restrictive).
10. To apply non-surgical treatment (e.g. patching, atropine penalization) of
more complicated forms of amblyopia (e.g. non-compliant, patching
failures).
11. To recognize, evaluate, and treat the most complex forms of childhood
nystagmus (e.g. sensory, spasmus nutans, associated with neurologic or
systemic disease).
12. To recognize and treat (or refer for treatment) complex retinopathy of
prematurity (e.g. stages, treatment indications, retinal detachment).
13. To recognize and treat (or refer for treatment) uncommon etiologies and
types of pediatric cataracts (e.g. congenital, traumatic).
14. To recognize and appropriately evaluate the more complex hereditary
ocular syndromes (e.g. bilateral Duane syndrome, Mobius syndrome).
15. To recognize and treat (or refer for treatment) patients with complicated
retinoblastoma (e.g. bilateral cases, monocular patient, treatment failure,
pineal involvement).
16. To recognize and evaluate the less common congenital ocular anomalies
(e.g. unusual genetic syndromes).
17. To apply the most advanced principles of binocular vision and amblyopia
(e.g. physiology of binocular vision, diplopia, confusion and suppression,
normal and abnormal retinal correspondence, classification and
characteristics of amblyopia).
18. To recognize and treat complex pediatric retinal disease (e.g. inherited
retinopathies, retinopathy of prematurity).

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19. To recognize and treat complex pediatric glaucoma.

20. To recognize and treat complex pediatric cataracts and anterior segment
abnormalities (including surgical implications, techniques, and
complications).
21. To recognize and treat complex pediatric eyelid disorders (e.g. lid
lacerations, lid tumors).
22. To recognize and treat (or refer) pediatric orbital disease (e.g. orbital
tumors, orbital fractures, rhabdomyosarcoma, severe congenital orbital
malformations).

B. Technical/surgical Skills:
1. To perform more complex extraocular muscle surgery (e.g. vertical and horizontal
muscle surgery; re-operations).
2. To describe indications and contraindications for more complex strabismus
surgery.
3. To describe and perform the pre-operative assessment, intraoperative techniques
and to describe postoperative complications for more complicated strabismus
surgery (e.g. re-operations, slipped muscle)
4. To describe indications for and to perform adjustable sutures in more complicated
cases (e.g. thyroid ophthalmopathy).
5. To describe and manage more complex complications of strabismus surgery (e.g.
globe perforation, endophthalmitis, overcorrection).

VITREO-RETINAL DISEASE
JUNIOR RESIDENCY YEAR 1
A. Cognitive Skills:
1. To describe basic principles of retinal anatomy and physiology (layers of the
retina, retinal physiology).
2. To describe fundamentals and demonstrate basic understanding of fluorescein
angiography as applied to retinal vascular disease (e.g. phases of the angiogram,
indications).

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3. To describe etiologies and mechanisms of retinal detachment.

4. To describe macular anatomy and function and to describe typical features of
common macular disease (e.g. age-related macular degeneration, macular hole,
macular dystrophies).
5. To describe basic principles of laser photocoagulation.
6. To describe and recognize features of commotio retinae, traumatic choroidal
rupture, and Purtscher's retinopathy.
7. To describe common forms of retinal vascular disease (e.g. branch, hemicentral retinal vein and artery occlusion).

or

8. To describe typical features of retinitis pigmentosa.

9. To describe features of, recognize, and evaluate posterior vitreous detachments
B. Technical Skills:
1. To perform direct ophthalmoscopy.
2. To perform indirect ophthalmoscopy.
3. To perform slit lamp biomicroscopy with the Hruby, +78, or +90 lenses, and 3mirror or other fundus contact lens.
4. To interpret basic fluorescein angiography in common retinal disorders (e.g.
diabetic retinopathy, cystoid macular edema).

JUNIOR RESIDENCY YEAR 2

A. Cognitive Skills:
1. To describe more advanced retinal anatomy and physiology.
2. To describe more advanced concepts of fluorescein and indocyanine green (ICG)
angiography as applied to retinal vascular and other diseases (e.g. phases of the
angiogram, indications).
3. To describe principles of retinal detachment recognition, various types of retinal
detachment (e.g. exudative, rhegmatogenous, tractional), and their evaluation,
management and repair (e.g. identify retinal break).
4. To describe and recognize typical features of less common macular disease (e.g.
parafoveal telangiectasias, cone dystrophies, toxic maculopathies).
5. To describe indications for and complications of laser photocoagulation.

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6. To describe the findings of major studies in retinal diseases, including but not
restricted to the following:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.

Diabetic Retinopathy Study (DRS)

Diabetic Vitrectomy Study (DVS)
Early Treatment of Diabetic Retinopathy Study (ETDRS)
Macular Photocoagulation Study (MPS)
Diabetes Control and Complications Trial (DCCT)
Branch Vein Occlusion Study (BVOS)
Central Vein Occlusion Study (CVOS)
United Kingdom Prospective Diabetes Study (UKPDS)
Age-Related Eye Disease Study (AREDS)
Verteporfin in Photodynamic Therapy Study (VIP)
Treatment of Age-Related Macular Degeneration with Photodynamic
Therapy Study (TAP); etc

7. To describe the fundamentals of, evaluate, and treat (or refer) peripheral retinal
disease and vitreous pathology (e.g. vitreous hemorrhage, retinal breaks).
8. To describe, evaluate, and treat choroidal detachments.
9. To identify and evaluate retinoschisis (e.g. juvenile, senile).
10. To diagnose, treat, and recognize the complications of retinopathy of prematurity
(e.g. retinal detachment).
11. To diagnose, evaluate, and treat the following retinal vascular diseases
a. Arterial and venous obstructions
b. Diabetic retinopathy
c. Hypertensive retinopathy
d. Peripheral retinal vascular occlusive disease
e. Acquired retinal vascular diseases
f. Ocular ischemic syndrome
g. Sickle cell retinopathy
12. To describe and recognize common and uncommon macular disorders
a. Age-related macular degeneration (ARMD)
b. Choroidal neovascularization (e.g. ARMD, histoplasmosis)
c. High myopia
d. Macular dystrophies
e. Macular pucker (e.g. epiretinal membrane)
f. Macular holes
h. Cystoid macular edema
i. Central serous choroidopathy (retinopathy)
j. Optic pit and secondary serous detachment
1. To describe the fundamentals of retinal electrophysiology.
2. To describe, recognize, and evaluate hereditary retinal and choroidal diseases
(e.g. gyrate atrophy, choroideremia, retinitis pigmentosa, cone dystrophies,
Stargardt's disease, Best's disease, congenital stationary night blindness).
3. To recognize, evaluate, and treat (or refer) retinal and choroidal toxicity (e.g.
phenothiazine, hydroxychloroquine/chloroquine toxicity, tamoxifen).
72

4. To describe the techniques for retinal detachment repair (e.g. pneumatic

retinopexy, scleral buckling, vitrectomy).
5. To describe the basics of surgical vitrectomy (e.g. mechanics, instruments,
indications, and technique).
6. To describe the indications for and perform basic laser treatment for diabetic
retinopathy (e.g. pan-retinal photocoagulation; macular grid).
7. To describe the fundamentals of special vitreoretinal techniques
a. Macular hole repair
b. Epiretinal membrane peeling
c. Complex vitrectomy for proliferative vitreoretinopathy
d. Use of heavy liquids and intraocular gases (e.g. perfluorocarbons)
8. To describe posterior uveitis syndromes and endophthalmitis.
B. Technical Skills:
1. To perform indirect ophthalmoscopy with scleral indentation.
2. To perform ophthalmoscopic examination with contact lenses, including panfunduscopic lenses.
3. To interpret fluorescein and ICG angiography.
4. To describe the indications for and interpret retinal imaging technology (e.g.
ocular coherence tomography, retinal thickness analysis).
5. To perform posterior segment photocoagulation.
6. To perform diabetic focal/grid macular laser treatment.
7. To perform peripheral scatter photocoagulation (panretinal).
8. To perform laser retinopexy (demarcation) for simple retinal breaks.
9. To describe the indications for and interpret basic electrophysiological tests (e.g.
electroretinogram [ERG], electro-oculogram [EOG], visual evoked potential
(VEP), dark adaptation).
10. To interpret basic ocular imaging techniques (e.g. B-scan echography, nerve fiber
layer analysis).
11. To perform fundus drawings of the retina, showing complex vitreoretinal
relationships and findings.

73

12. To perform cryotherapy of retinal holes and other pathology.

13. To perform scleral buckling.
14. To describe indications, techniques, and complications of pars plana vitrectomy
and to assist in a retinal surgery or perform the procedure under supervision.

SENIOR RESIDENCY
A. Cognitive Skills:
1. To apply in clinical practice the most advanced knowledge of retinal anatomy and
physiology (e.g. surgical anatomy).
2. To apply in clinical practice the most advanced concepts of fluorescein/ICG
angiography in complex retinal vascular and other diseases (e.g. occult choroidal
neovascular membranes, recurrent neovascularization, vascular tumors, diseases
of the choroid and retinal pigment epithelium).
3. To evaluate, treat or refer the most complex retinal detachments (e.g. recurrent
retinal detachment, proliferative vitreoretinopathy).
4. To evaluate, treat or refer the most complex macular disease (e.g. recurrent
neovascular membranes).
5. To describe the indications for laser photocoagulation, including photodynamic
therapy for the most complex retinal pathology (e.g. subfoveal neovascular
membranes).
6. To describe the findings of the major studies in retinal diseases and describe the
indications and exceptions for application to individual patients
a. Diabetic Retinopathy Study (DRS)
b. Diabetic Vitrectomy Study (DVS)
c. Early Treatment of Diabetic Retinopathy Study (ETDRS)
d. Macular Photocoagulation Study (MPS)
e. Diabetes Control and Complications Trial (DCCT)
f. Branch Vein Occlusion Study (BVOS)
g. Central Vein Occlusion Study (CVOS)
h. United Kingdom Prospective Diabetes Study (UKPDS)
i. Treatment of Age-related Macular Degeneration with Photodynamic
Therapy (TAP; VIP)
j. Others

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7. To apply in clinical practice understanding of the most complex peripheral retinal

disease and vitreous pathology (e.g. Goldmann Favre disease, incontinentia
pigmenti,
familial exudative vitreoretinopathy).
8. To evaluate and treat complications of retinal photocoagulation (e.g. vitreous
hemorrhage, chorioretinal anastomoses).
9. To recognize and treat complex retinal detachments (e.g. giant tear).
10. To evaluate, treat or refer the more complex cases of retinopathy of prematurity
(e.g. tractional retinal detachment).
11. To evaluate, treat or refer the most complex forms of retinal vascular disease
a. Combined arterial and venous obstructions
b. Advanced diabetic retinopathy
c. Advanced hypertensive retinopathy
d. Peripheral retinal vascular occlusive disease
e. Acquired retinal vascular diseases
12. To evaluate and treat or refer the uncommon manifestations or presentations of
the following macular diseases
a. Age-related macular degeneration (ARMD)/choroidal neovascularization,
(e.g. recurrent subfoveal neovascularization).
b. Uncommon macular dystrophies
c. Refractory cystoid macular edema
d. Recurrent central serous choroidopathy (choroidoretinopathy)
13. To apply in clinical practice the more complex retinal electrophysiology (e.g.
multi-focal electroretinography).
14. To apply in clinical practice the more complex techniques for retinal detachment
repair
a. Repeat scleral buckling
b. Pars plana vitrectomy (e.g. diagnostic tap; core vitrectomy)
15. To apply in clinical practice the more complex principles of surgical management
of diabetic retinopathy (e.g. vitrectomy, membrane release).
16. To apply in clinical practice complex vitreoretinal techniques
a. Macular hole repair
b. Epiretinal membrane peeling
c. Complex vitrectomy for proliferative vitreoretinopathy
d. Use of heavy liquids
75

17. To evaluate and treat or refer the etiologically more complex or uncommon cases
of posterior uveitis (e.g. sympathetic ophthalmia) and endophthalmitis (e.g.
endogenous).
B. Technical/surgical Skills:
1. To perform indirect ophthalmoscopy with scleral indentation in complex retinal
cases (e.g. multiple holes, documented with retinal drawing).
2. To perform ophthalmoscopic examination with pan-funduscopic or other lenses in
complex retinal conditions (e.g. giant retinal tears, proliferative
vitreoretinopathy).
3. To interpret and apply in clinical practice the results of fIuorescein and ICG
angiography in complex retinal or choroidal pathology (e.g. occult subretinal
neovascular membrane).
4. To perform posterior segment photocoagulation in more complicated retinal cases
a. Diabetic focal/grid macular treatment (e.g. monocular patient, repeat
treatment)
b. Repeat peripheral scatter photocoagulation (panretinal)
c. Laser retinopexy (demarcation) of large breaks; cryotherapy
5.

To interpret and apply in clinical practice electrophysiology (e.g. ERG, EOG,

VEP, dark adaptation) in more complicated retinal pathology.

6. To interpret and apply in clinical practice ocular imaging techniques (e.g. B-scan
echography) in more complex cases (e.g. choroidal osteoma).
7. To perform fundus drawings of the retina with vitreoretinal relationships in the
most complex retinal cases (e.g. recurrent retinal detachment, retinoschisis with
and without retinal detachment).
8. To perform laser therapy or cryotherapy of retinal holes and other more complex
retinal pathology.
9. To perform scleral buckling in complex retinal detachment.
10. To perform advanced pars plana vitrectomy.

UVEITIS
JUNIOR RESIDENCY YEAR 1
A. Cognitive Skills:
1. To describe basic principles of history taking and examination of patients with
uveitis.

76

2. To list signs and symptoms of anterior and posterior uveitis (eg., red eye, blurred
vision, anterior segment cell and flare, vitreous opacities, pars planitis, retinal or
choroidal infiltrates).
3. To describe the different types of uveitis (e.g. acute and chronic uveitis,
granulomatous and non-granulomatous uveitis, anterior, intermediate, and
posterior uveitis).
4. To describe typical features and differential diagnosis of anterior uveitis,
including infectious (e.g. bacterial, viral, protozoal, parasite), inflammatory (e.g.
sarcoid, HLA-B27-associated, Behcet's disease, collagen vascular disease),
neoplastic (masquerade syndromes), post-surgical, post-traumatic, Fuchs'
heterochromic uveitis.
5. To describe typical features and differential diagnosis of the following posterior
segment uveitis
a. Toxoplasmosis
b. Sarcoidosis
c. Pars planitis
d. Acute retinal necrosis
e. Vogt-Koyanagi-Harada syndrome
f. Large cell lymphoma
g. Post-operative uveitis
h. Endophthalmitis (e.g. post-operative, traumatic, endogenous, fungal,
phacoanaphylactic, sympathetic ophthalmia)
i. Unusual infectious etiologies for uveitis (e.g. human immunodeficiency
virus, herpes simplex virus, herpes zoster virus, pneumocystis carinii)
j. Acquired and congenital ocular syphilis
k. Cytomegalovirus retinitis

B. Technical Skills:
1. To perform an examination of the anterior and posterior segment for uveitis (e.g.
slit lamp biomicroscopy, scleral depression, magnified posterior segment exam,
vitreous evaluation for celIs, retinal, choroidal, and pars plana evaluations).
2. To describe indications for ancillary testing in the evaluation of uveitis (e.g.
fluorescein angiography, ultrasound, laboratory testing, radiologic testing).

77

JUNIOR RESIDENCY YEAR 2

A. Cognitive Skills:
1. To describe more advanced principles of history taking and examination of
patients with uveitis (e.g. review of systems for Wegener's granulomatosis,
polyarteritis nodosa, evaluation of skin, cardiac, respiratory, renal, pulmonary,
musculoskeletal systems)
2. To list less common signs and symptoms of anterior and posterior uveitis.
3. To list differentiating signs of less common forms of uveitis (e.g. iris nodules,
conjunctival ulcer or granuloma).
4. To describe the differential diagnosis of less common forms of uveitis (e.g.
chronic uveitis, intermediate uveitis (eg., pars planitis), and infectious (e.g.
Whipple disease, syphilis) or inflammatory posterior uveitis.
5. To evaluate and treat common causes of anterior and posterior uveitis.
B. Technical Skills:
1. To perform a directed examination of the anterior and posterior segment for
uveitis (e.g. slit lamp biomicroscopy, scleral depression, magnified posterior
segment exam, vitreous evaluation for cells).
2. To perform ancillary testing in the evaluation of uveitis (e.g. fluorescein
angiography, ultrasound, laboratory testing, radiologic testing).

SENIOR RESIDENCY
A. Cognitive Skills:
1. To recognize, evaluate and treat uveitis associated with immunosuppressed
individuals (e.g. active and recovered acquired immune deficiency syndrome,
pharmacologic immunosuppression).
2. To recognize, evaluate and treat acquired and congenital ocular syphilis.
3. To recognize, evaluate and treat (or refer) less common, rare, or tropical conditions
associated with uveitis (e.g. leishmaniasis, onchocerciasis, etc.).
4. To describe indications and contraindications for corticosteroid treatment of uveitis
(e.g. topical, local, systemic), including risks and benefits of therapy.
5. To describe indications
in uveitis.

and contraindicationsfor immunuosuppressive therapy

78

B. Technical Skills:
1. To administer steroids in the treatment of uveitis by various routes.
2. To administer immunosuppressive agents in uveitis (or refer for administration).
3. To evaluate and treat the complications of uveitis therapy (e.g. cataracts,
glaucoma).
4. To biopsy, when indicated, the vitreous or uveal tract.
5. To insert intravitreal implants containing antiviral or corticosteroid medications.
6. To perform, when indicated, vitrectomy or scleral buckling procedures.

OCULAR ONCOLOGY
JUNIOR RESIDENCY YEAR 1
A. Cognitive Skills:
1. To describe the basic categorization of common extra- and intraocular tumors.
2. To describe the differential diagnosis, epidemiology, evaluation, and
management of leucocoria (e.g. inflammatory, infectious, neoplastic, congenital,
persistent fetal vasculature, cataract, Coats' disease, vitreous hemorrhage, retinal
detachment).
3. To describe major diagnostic features of major intraocular tumor types (e.g.
retinoblastoma, choroidal melanoma, metastatic lesions) and to describe the
differentiating features of similar lesions.
B. Technical Skills:
1. To perform slit lamp, ophthalmoscopic and ocular transillumination examination
of patients with intraocular tumors (e.g. choroidal melanoma).
2. To recognize an ocular tumor and refer appropriately.
JUNIOR RESIDENCY YEAR 2
A. Cognitive Skills:
1. To describe management options for different intraocular tumors.
2. To describe the findings of the Collaborative Ocular Melanoma Study (COMS).
3. To describe the classification of retinoblastoma.

79

4. To describe basic histopathology of intraocular tumors.

5. To list the differential diagnoses for tumors of the iris, ciliary body, choroid,
retina and optic disc (e.g. melanoma, retinoblastoma, hemangioma,
melanocytoma).
6. To describe diagnostic techniques for common intraocular tumors (e.g. physical
examination, imaging, laboratory, oncology referral).
7. To describe the prognostic significance of different types of ocular tumors and to
be able to guide evaluation for systemic involvement.
B. Technical Skills:
1. To perform indirect ophthalmoscopy in the diagnosis and localization of
intraocular tumors.
2. To perform transillumination for intraocular tumor.
3. To describe indications for an examination under anesthesia for pediatric
intraocular tumors.
4. To describe indications for A and B-scan echography of intraocular mass lesions.
5. To describe indications for fluorescein angiography of intraocular tumors.
6. To describe indications for destruction or excision of conjunctival, corneal and
intraocular tumors.
7. To describe indications for laser photocoagulation for intraocular tumors.
8. To describe indications for and techniques of transpupillary thermal therapy for
intraocular tumors.
9. To recognize major histopathologic appearance of common intraocular tumors.
10. To describe the indications for surgical or other therapeutic procedures and their
complications, and for referral, if necessary, for:
a. Plaque or other radiotherapy
b. Iridectomy and iridocyclectomy
c. Resection of conjunctival tumors
11. To perform an enucleation.
12. To describe indications for and techniques and complications of radiation therapy
for ocular tumors (e.g. radioactive plaque localization, external beam radiation).
13. To discuss various treatment options with patients and their families in a detailed,
ethical, and compassionate manner.

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SENIOR RESIDENCY
A. Cognitive Skills:
1.

To describe management options for unusual intraocular tumors (e.g. choroidal

metastasis, choroidal osteoma).

2. To apply the findings of the Collaborative Ocular Melanoma Study (COMS).

3. To recognize, evaluate, and treat all forms of extra- and intraocular tumors.
B. Technical Skills:
1. To perform indirect ophthalmoscopy in the diagnosis and localization of
intraocular tumors prior to treatment.
2. To describe indications for and to perform an examination under anesthesia for
pediatric intraocular tumors (e.g. retinoblastoma).
3. To describe indications for and to interpret A and B-scan echography of intraocular
mass lesions.
4. To describe indications for and to interpret of fluorescein angiography of
intraocular tumors.
5. To describe indications for and to perform excision or other treatment of
conjunctival, corneal, and intraocular tumors.
6. To describe indications for and to perform laser photocoagulation for intraocular
tumors.
7. To recognize major histopathologic appearance of common and less common
intraocular tumors.
8. To describe indications for surgical procedures and their complications and be
able to perform or to refer for:
a. Plaque radiotherapy
b. External beam radiotherapy
c. Iridectomy and iridocyclectomy
d. Resection or cryotherapy of conjunctival tumors, or use of antimetabolite eye
drops
e. Transpupillary thermal therapy
9. To perform a complicated enucleation (e.g. complicated by hemorrhaging, small
orbit, scar tissue) or exenteration.

LOW VISION REHABILITATION

JUNIOR RESIDENCY YEAR 1

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A. Cognitive Skills:
1. To describe low vision assessment techniques, (e.g. Early Treatment of Diabetic
Retinopathy Study (ETDRS) charts, Sloane charts).
2. To describe significant co-morbidities that impact low vision rehabilitation.
3. To describe various low vision aids.
4. To describe the optics of low vision devices.
5. To be sensitive to psychological and emotional aspects of visual impairment.
6. To describe challenges commonly encountered by individuals with visual
impairments.
7. To prescribe simple but appropriate rehabilitative therapies and optical devices to
help the patient meet his/her goals (e.g. magnification, illumination).
8. To describe functional implications of various visual system pathologies and
diseases.
9. To describe visual field enhancing techniques for hemianopic field loss.
10. To describe the difference between visual acuity testing at both distance and near
and contrast sensitivity testing.
11. To describe the evaluation of and rationale for licensing automobile drivers who
are visually impaired.
12. To describe evaluation of visual acuity and visual field for disability
determination.

JUNIOR RESIDENCY YEAR 2

A. Cognitive Skills:
1. To recognize significant co-morbidities that impact low vision rehabilitation.
2. To recognize and describe clinical applications, indications, and limitations of
the various low vision aids (e.g. closed circuit television, magnification, large
print, Braille, computers with artificial speech).
3. To describe the more advanced optics of low vision devices.
B. Technical Skills:
1. To prescribe more complex rehabilitative therapies and optical devices to help
the patient meet his/her goals.
2. To apply and prescribe visual field enhancing techniques for hemianopic field
loss.

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3. To perform evaluation of vision assessment in licensing drivers who are visually

impaired.
4. To evaluate visual acuity and visual field fix disability determination.
5. To demonstrate low vision devices and educate low vision patients on the uses
and limitations of these devices.
SENIOR RESIDENCY
A. Cognitive Skills:
1. To treat significant co-morbidities that impact low vision rehabilitation.
2. To describe indications for the most complex low vision aids.
3. To apply more complex principles of optics of low vision devices.
B. Technical Skills:
1. To prescribe the most complex rehabilitative therapies and optical devices to help
the patient meet his/her goals.
2. To apply and prescribe the most complex visual field enhancing techniques for
hemianopic field loss.

OPHTHALMIC PRACTICE MANAGEMENT

JUNIOR RESIDENCY
1. To describe the fundamentals and principles of medical ethics in
ophthalmology (e.g. patient care decision-making, informed consent,
competency issues, ethics of inter-collegial relations, risk management, privacy
issues).
2. To describe the basics of ophthalmic practice management (e.g. contractual
negotiations, hiring and supervising employees, financial management, working
with associates, billing/collecting).
3. To describe the basics of the health care system and insurance reimbursement
in Nigeria.

SENIOR RESIDENCY I
1. To describe and apply more advanced principles of medical ethics (e.g. life and death
patient care decision-making, ethics of optometric and non-physician relations,
documentation requirements, claims in risk management).

83

2. To describe and apply more advanced aspects of practice management (e.g. business
models, documentation requirements and coding, privacy requirements, dealing with
patients or employees with disabilities ).
3. To describe and apply more advanced aspects of health care reimbursement (e.g.
physicians' role in managed care organizations, administrative role, third party
reimbursement, capitated programs).
SENIOR RESIDENCY II
1. To demonstrate proficiency in more advanced principles of medical ethics (e.g.
informed consent in children, the mentally ill or disabled, or the demented
patient; physician and industry relationships; acceptance and disclosure of gifts
or consultation fees).
2. To utilize in clinical practice the principles of practice management (e.g.
starting a practice, economics of starting a practice, licensing and
credentialling applications).
3. To utilize in clinical practice more advanced aspects of health care
reimbursement (e.g. denials of claims, hospital contracting, electronic billing).

84

APPENDIX I
Literature and Studies for Review:
General References (Books). This list though not exhaustive includes
The Herpetic Eye Disease Study (HEDS)
The Fluorouracil Filtering Surgery Study (FFSS)
The Normal Tension Glaucoma Study
The Ocular Hypertension Study (OHTS)
The Glaucoma Laser Trial (GLT)
The Optic Neuritis Treatment Trial (ONTT)
The Ischemic Optic Neuropathy Decompression Trial (IONDT)
Studies of the Ocular Complications of AIDS (SOCA)
Branch Vein Occlusion Studies (BVOS)
Macular Photocoagulation Study (MPS)
Age-Related Eye Disease Study (AREDS)
Verteporfin in Photodynamic Therapy (VIP) Study
Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP)
Silicone (oil) Study
The Submacular Surgery Trials (SST)
The Multicenter Trial of Cryotherapy for Retinopathy of
Prematurity (CRYO-ROP)
Central Vein Occlusion Studies (CVOS)
Diabetes Control and Complications Trial (DCCT)
Diabetic Retinopathy Study (DRS)
Early Treatment Diabetic Retinopathy Study (ETDRS)
Randomized Trial of Acetazolamide for Uveitis-Associated Cystoid Macular Edema
Collaborative Ocular Melanoma Study (COMS), etc.
Selected Review Articles, etc.

85

APPENDIX II:
STRUCTURED RESIDENCY TRAINING PROGRAMME
Duration /
Year
1.

Q1Jan-Mar
Introductory
ophthalmology
Basic clinical skills
Refraction/orthoptic
techniques
Wet lab practice

Neuro-ophthalmology/
Oculoplastics
Biostatistics/
epidemiology
Optics/refraction
revision course

Advanced neuroophthalmology: MRI,

CT scan interpretation

Community
Ophthalmology course/
posting

Q2 Apr-Jun
Optics/refraction
Basic surgical skill
course/practice
External
diseases/cornea
Refraction/orthoptic
techniques contd.
Pediatric
ophthalmology
Clinical
ophthalmology
revision course

Advanced vitreoretina: fluorescein

angio, ICG, OCT, etc
Laser: PRP, focal,
grid, etc.
Advanced pediatric
ophthalmology

Q3 Jul-Sept
External
disease/cornea contd
basic surgical skill
course/practice
Tissue biopsy
Cornea repair

Q4 Oct-Dec
Cataract/Glaucoma
Clinical investigations
Stepped intraocular
surgery practice
Visual fields

Monitoring/Evaluation
Evaluation of records:
refraction; wet lab;
surgery
Qualitative/Quantitative
assessment of Skill
portfolio.

Assessment
Continuous
Assessment Tests
each quarter
ICO Part I exam

Vitreo-retina: retinal
detachment
Clinical investigations:
use of lasers,
ultrasound
Literature review
Approach to
Dissertation writing

Introduction to
Community/Public
Health ophthalmology
Dissertation topic
selection
Data collection
techniques

Review of records of
surgical skills,
refraction, & clinical
investigations
Logbook assessment

Continuous
assessment tests
each quarter; mock
exam; Part I Exam;
ICO Part I exam

Advanced
glaucoma/cataract:
SICS, PHACO

Advanced cornea/
external disease:
keratoplasty, refractive
surgery etc

ICO exam;
Continuous
assessment tests
each quarter

Dissertation
review/submission

Revision
Review log book

Mock exam
Part II Final exam

Advanced oculoplastics
Difficult cataract cases

Oncology;
Difficult glaucoma
cases

86

APPENDIX III

"
TRAINERS RIGHTS
Trainer has the right to determine how and when residents are sent for postings.

Trainer has the right to accept or refuse training of a resident

Trainer has the right to objectively evaluate the effort of residents' "

Trainer has the right to sign up residents for exanimations

Trainer has the right to reprimand erring residents within the hospital's disciplinary
measures
Trainer has the right to expect respect and honour from residents (Hippocratic Oath)

TRAINERS RESPONSIBILITIES
Trainer is responsible for organizing:

Outpatient clinic training sessions

*Consultants teaching ward rounds

Journal sessions

Clinical evaluation sessions

Outside postings.

*. Grand rounds for residents

Chief residents status can assist the trainer in achieving some of these responsibilities.
*
Trainer has the responsibility of signing residents for examinations
Trainer has the passive responsibility of training residents such that they pass examinations
in record time.
Trainer has the responsibility to discipline residents but n6t abuse residents. (Discipline
becomes abuse when threats are used and there is donkey use of residents for duties not
linked to training)
How to discipline - Delay postings, refuse to sign up the resident if adjudged not ready for
exams, issue queries for tardiness and shirking of duties.

MOTIVATION BY TRAINERS
Informal sessions with residents to find out their difficulties
One on one counseling of residents with problems
Above all motivation by showing good example. Leadership by example
RESIDENTS RIGHTS
Resident has the right to expect structured training program
Resident has the right to expect clinical teaching sessions
Resident has the right to expect surgical training sessions
Resident has the right to expect objective evaluation by trainer
Resident has the right to expect leadership by example from the trainer
Resident has the right to expect informed directives from trainers concerning residency
curriculum.(Trainers must be familiar with NPMC handbook for residents and trainers)
RESPONSIBILITIES OF RESIDENT
The resident has the responsibility of making sure postings are completed before exams
Residents have the responsibility of attending all clinical rounds, ward rounds, surgical
sessions, grand rounds, and teaching rounds structured to train them adequately.
Residents have the responsibility of working hard to meet examination requirements and pass
exams in record time.
Residents have the responsibility of giving respect and honour to their trainers
Residents have the responsibility of making sure log books are duly filled with trainers
signatures for procedures performed.
Residents have the responsibility to finance their examinations and conduct themselves
properly during the examination.
Residents have the responsibility of working in accordance with Nigerian Medical and
Dental Counsel's medical code of ethics i.e. Dont get involved in private practice without
supervision- i.e. cataract surgery (Avoid malpractice).

APPENDIX IV
FACULTY OF OPHTHALMOLOGY
NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA
FORM A: COGNITIVE DOMAIN :
QUARTER (Q)/YEAR/...
CONTINUOUS ASSESSMENT RECORD FOR RESIDENCY TRAINING NPGMCN
NAME OF CANDIDATE............. YEARS IN TRAINING.
PLEASE FILL ALL SPACES
*NP
GRADE (Please enter scores ONLY in the spaces provided)
ACTIVITIES (See keys)
Unit/Dept

Unit/Dept

Unit/Dept

Unit/Dept

Unit/Dept

Unit/Dept

Clinical Meetings
Seminars/Tutorials
Journal Club Meeting
Ward Rounds (Records)
Medical Audit (Records)
Assignments
Long Cases
Short Cases
Outreaches (Reports)
Research (Records)
Continuous Assessments
Essays
SAQ
MCQ
OSCE
Orals
Mock Exam
Others
Total score

*NP Number Performed,

- See Remarks.

Remarks

Keys:
Grade

Sign:

Descriptions

Scores

Excellent

= 80% and above

=7

Very Good

= 60-70%

=6

Good

= 50-59%

=5

Fair

= 40-49%

=4

Poor

= Below 40%

=3

Not Done (ND)

= 0%

=0

Not Applicable (NA)

OTC

HOD

Consultant

(Please justify)

FORM B: PSYCHOMOTOR
: QUARTER (Q)/YEAR/...
CONTINUOUS ASSESSMENT RECORD FOR RESIDENCY TRAINING NPGMCN
NAME OF CANDIDATE............. YEARS IN TRAINING.
PLEASE FILL ALL SPACES
*N P
GRADE (Please enter scores ONLY in the spaces provided)
ACTIVITIES (See Keys)
Investigations:

Unit/Dept

A
Unit/Dept

B
Unit/Dept

Tonometry
Gonioscopy
BIO
78/90D
3-Mirror Lens
CVF/FDT
Hruby Lens
Histopathology slides
OCT
Exophthalmometer
FFA
Refraction
Side Lab
Ultrasonography
Others..
Surgeries:

C
Unit/Dept

D
Unit/Dept

E
Unit/Dept

Remarks

Wet Lab (Records)

Cataract:
ECCE + PCIOL
SICS + PCIOL
Phaco + PCIOL
Others..
Glaucoma:
Trabeculectomy
LTP
Cyclophotocoagulation
Laser Iridotomy
Others.
Retina:
Vitrectomy
Intra Vitreal injections
PRP
Scleral Buckling
Others..
Oculoplastic:
Lid Repairs
Tissue Biopsy
Orbitotomy
DCR
Others
Repairs Ocular Trauma
Enucleation/Evisceration
Exenteration
Others
Total Scores
Keys

Sign:

Grade
A
B
C
D
E
F
G

Consultant

Descriptions
Excellent = 80% and above
Very Good = 60-70%
Good
= 50-59%
Fair
= 40-49%
Poor
= < 40%
Not Done (ND)
= 0%
Not Applicable (NA) -

OTC

Scores
*NP- Number performed
=7
- See Remarks
=6
=5
=4
=3
= 0 (Please justify)
-

HOD

FORM C: AFFECTIVE DOMAIN

:
QUARTER (Q)/YEAR/...
CONTINUOUS ASSESSMENT RECORD FOR RESIDENCY TRAINING NPGMCN
NAME OF CANDIDATE............. YEARS IN TRAINING.
PLEASE FILL ALL SPACES
GRADE (Please enter scores only in the spaces provided)
BEHAVIOURS (See Keys)

Unit/Dept

Unit/Dept

Unit/Dept

Unit/Dept

Unit/Dept

Attendance (% overall)
Cognitive
Psychomotor
Residents Meetings
Hospital Meetings
Total Others (Specify).
Aesthetic Appreciation
Creativity
Honesty
Initiative
Leadership Role
Neatness
Obedience
Politeness
Punctuality
Self Control
Sense of Responsibility
Sociability
Organizational Ability
Perseverance
Spirit of Cooperation
Total Scores

Keys:
Grade
A

Descriptions
-

Scores

Excellent

= 80% and above

=7

Remarks

Sign:

Very Good

= 90-99%

=6

Good

= 75-89%

=5

Fair

= 60-74%

=4

Poor

= < 60%

=3

Absent/Not Done (ABS, ND)

= 0%

= 0 (Please justify)

Not Applicable (NA)

Consultant

OTC

HOD

SCORES

SUMMARY
Cognitive
Psychomotor
Affective
Sub Total

UNIT
.
.
.

DEPT
..
..
..

SUB TOTAL
.
.
.

Average

Comments:
..
..
Recommendations: .

Sign:
Consultant
Name: .
Date: .

OTC
.

HOD

APPENDIX V
RESOURCES FOR RESIDENCY TRAINING IN OPHTHALMOLOGY: RECOMMENDED
TEXTBOOKS
The American Academy of Ophthalmologys Basic Clinical and Science Course Vol 113 serve as the standard textbook for the structured training programme.
In addition to the books recommended for the basic sciences other books which
latest editions are recommended for the clinical sciences include:
1. Kanski JJ. Clinical ophthalmology: A systematic Approach
London: Butterworths
2. Peyman GA, Goldberg MF, Sanders DR. Principles and Practice of
Ophthalmology Vol. I III. Philadelphia: WB Saunders Company
3. Wilson II FM (ed.) Practical Ophthalmology A manual for beginning
residents. San Francisco: American Academy of Ophthalmology.
4. The Wills Eye Manual: Office and Emergency Room Diagnosis and
Treatment of Eye Disease. Philadelphia: JB Lippincott.
5. Abrams D. Duke Elders Practice of Refraction Practice. London:
Churchill Livingstone.
6. Tasman W, Jaeger EA. (eds). Duanes Clinical Ophthalmology.
Philadelphia: Lippincott Williams & Wilkins
7. Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology Vol.
I - VI. Philadelphia: WB Saunders Company

APPENDIX VI
THE FMCOph PROGRAMME CREDIT UNITS ASSIGNMENT / REQUIREMENTS FOR PRESENTING FOR
THE PARTS I & II PHASES OF THE FELLOWSHIP EXAMINATIONS

The Part One phase [148 CREDIT UNITS] consisting of:

Self-instructional learning for a minimum of 10hours a week [2hours/day] for 96 weeks [24 months]
Tutorials for 1hour per week for 96 weeks
(6
CREDIT UNITS)
Seminars, clinical meeting, journal club, etc., for 1hour per week for 96 weeks
(6
CREDIT UNITS)
Clinical (including basic ophthalmic surgery) training for 30hours per week [5hours per day for 6days
/week] for 96 weeks
(64 CREDIT
UNITS)
Mandatory Intensive Update Courses (i.e. Clinical Ophthalmology & Optics/Refraction Courses) 30 hours
per week [6hours/day] for 2 weeks for each course
(8 CREDIT
UNITS)
The Part Two phase [72 CREDIT UNITS] consisting of
Training in advanced clinical & surgical skills for 30hours per week [5hours per day for 6days /week] for 48
weeks
(32 CREDIT
UNITS)
Seminars, Tutorials, Facilitation of learning junior residents, etc., for 1hour per week for 96 weeks
(6
CREDIT UNITS)
Mandatory Health Management Workshops, 30 hours per week [6hours/day] for 2 weeks
(4
CREDIT UNITS)
Mandatory Research Methodology Workshops, 30 hours per week [6hours/day] for 2 weeks
(4
CREDIT UNITS)
Dissertation; proposal, literature gathering, field work, reporting.
(10 CREDIT UNITS)
Community ophthalmology course 30 hours per week (6 hours/day) for 4 weeks
(8
CREDIT UNITS)
Community Ophthalmology posting 30 hours per week (5 hours per day for 6 days /week) for 12 weeks
(8 CREDIT UNITS)
[TOTAL NUMBER OF CREDIT UNITS, OVER THE TRAINING PERIOD
=220 CREDIT UNITS]

APPENDIX VII
THE SUMMARY OF FMCOph PROGAMME
YEAR

COURSE CONTENT

YEAR 1

Introductory ophthalmology
Basic clinical skills
Refraction/orthoptic techniques
Wet lab practice
Optics/refraction
Basic surgical skill course/practice
External diseases/cornea
Refraction/orthoptic techniques contd.
External disease/cornea contd
basic surgical skill course/practice
Tissue biopsy; Cornea repair
Cataract/Glaucoma
Clinical investigations
Stepped intraocular surgery practice
Visual fields
Cataract/Glaucoma
Clinical investigations
Stepped intraocular surgery practice
Visual fields
Neuro-ophthalmology/Oculoplastics
Biostatistics/epidemiology
Optics/refraction revision course
Pediatric ophthalmology;
Clinical ophthalmology revision course
Vitreo-retina: retinal detachment
Clinical investigations: use of lasers, ultrasound
Literature review
Approach to Dissertation writing
Introduction to Community/Public Health ophthalmology
Dissertation topic selection
Data collection techniques
Advanced neuro-ophthalmology: MRI, CT scan interpretation
Advanced vitreo-retina: fluorescein angio, ICG, OCT, etc
Laser: PRP, focal, grid, etc.
Advanced oculoplastics
Difficult cataract cases
Advanced glaucoma/cataract: SICS, PHACO
Community Ophthalmology course/ posting
Advanced pediatric ophthalmology

YEAR 2

YEAR 3

YEAR 4

Ocular oncology; Difficult glaucoma cases: shunt procedures, etc.

Advanced cornea/ external disease: keratoplasty, refractive surgery, etc.

10

CREDIT
UNITS
17

18

18

18

18

13

18
18

18

10
10
10
10
12
6
7
7

APPENDIX VIII
TEMPLATE FOR TWENTY-STATION OBJECTIVE STRUCTURED CLINICAL EXAM/EVALUATION (OSCE)

TIME / ITEM

STATION 1

STATION 2

STATION 3

STATION 4

10minutes

Physical
Examination

Physical
Examination

Physical
Examination

Physical
Examination

10minutes

STATION 11
Recognition
and
Cognition

STATION 12
Recognition
and
Cognition

STATION 13
Recognition
and
Cognition

STATION 14
Recognition
and
Cognition

NOTE
1.
2.
3.

STATION 5
History of
Presenting
Complaints

STATION
15
Assess
other skills

STATION
6
Review of
Systems

STATION
16
Assess
other
skills

STATION 7
Family and
Social
History

STATION 8

STATIO

Ophthalmosco
skills

Refracti
skills

STATION
17

STATION 18

STATIO

Assess
other skills

Assess other
skills

Assess
skills

Tonometry

Suturing

From this Twenty-station template ten stations will be selected as a set which can be replicated as
required.
Ten stations assume a minimum of 20 examiners [2 per station].
The stations could be varied and extended up to 30 depending on he number of candidates and the
skills & knowledge being tested

MEMBERS OF THE RESIDENCY HANDBOOK REVIEW COMMITTEE:

1. Prof Sebastian N N NWOSU - Chairman
2. Dr Benedictus GK AJAYI
3. Dr Uduak ASANA
4. Dr Victoria A PAM
5. Dr Adeyinka O Ashaye
OFFICERS OF THE FACULTY:
Prof Rich E UMEH Chairman
Dr Haroun A AJIBODE Secretary
Prof Sebastian N N NWOSU -3rd Senate Member

11

12